US Call For New Powers Against Health Fraud

Health care fraud is US Attorney General Janet Reno's number two new initiative after violent crime, Gerald Stern, Special Counsel for Health Care Fraud at the Department of Justice, has told the House Small Business Committee regulation subcommittee.

Mr Stern told a hearing chaired by Representative Ron Wyden that provisions against Medicare and Medicaid kickbacks should be expanded to cover fraud affecting all health care payers, under criminal and civil actions. A kickback paid in connection with business paid for by a private health plan or a non-Medicare government plan is just as corrupting as one paid for by medicare, he said. The lack of such provisions causes confusion and unnecessary litigation, and "allows unscrupulous providers the opportunity to exploit what they claim are loopholes in the law."

Fraud Investigations Up 67% In A Year He said the number of criminal health fraud cases investigated by the Justice Department rose 67% from 621 in the year to September 30, 1993, to 1,041 in the year to August 31, 1994, while civil cases rose 119% from 411 to 899. Amending the Medicare and Medicaid statute to include civil actions could make it easier to prove intent to violate the law than under criminal law, he said, and another reason to broaden the statute is the finding that "when somebody is defrauding one part of the system, they are usually defrauding other parts as well."