Fighting Fraud and Abuse

December 21, 2010

Sebelius and Holder Announce New Tools to Prevent and Fight Fraud at Boston Regional Healthcare Fraud Prevention Summit


As part of the Obama Administration's ongoing efforts to prevent and fight fraud in the health care system, US Department of Health & Human Services Secretary Sebelius and Attorney General Eric Holder announced yesterday that the Centers for Medicare and Medicaid Services would be acquiring new state-of-the-art fraud fighting analytic tools to prevent wasteful and fraudulent payments in Medicare, Medicaid and the Children's Health Insurance Program.


Sebelius and Holder made the announcement at the University of Massachusetts, Boston at the fourth regional health care fraud prevention summit.  The Attorney General and the HHS Secretary have crisscrossed the country this year bringing together a wide array of federal, state, and local partners, beneficiaries, and providers to discuss innovative ways to eliminate fraud within the US health care system.


As part of today's summit, CMS will issue today a solicitation for state-of-the-art fraud fighting analytic tools to help the agency predict and prevent potentially wasteful, abusive, or fraudulent payments before they occur.  These tools will integrate many of the Agency's pilot programs into the National Fraud Prevention Program and complement the work of the joint HHS and Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT).


The recently-enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account.  The Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses. 


For information on the 2009 Health Care Fraud and Abuse Control Program Report, please visit

To read the entire HHS Release issued on Thu Dec 16, please visit


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