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…and you thought the RACs were HOT?

The HEAT are even hotter. No, we’re not talking about the Miami HEAT basketball squad. We’re talking about the fed’s newest and perhaps most wide-reaching “tool” for fighting fraud and abuse in Medicare and Medicaid program reimbursements: HEAT, or the Health Care Fraud Prevention & Enforcement Action Team.

The DOJ recently announced its largest health care fraud settlement in its history: the pharmaceutical giant Pfizer Inc. agreed to pay $2.3 Billion to resolve criminal and civil liability cases arising from the illegal promotion of certain pharmaceutical products. Of that $2.3 Billion, $1.195 Billion is a criminal fine, the largest fine ever imposed for anything, ever, in the US.

The settlement is the result of six (!) Whistleblower lawsuits filed in the District of Massachusetts, the Eastern District of Pennsylvania and the Eastern District of Kentucky. The whistleblowers will now receive approximately $1.2 Million dollars from the federal portion of the civil suit recoveries.

“Who ARE those guys?”   – Butch Cassidy, in “Butch Cassidy & the Sundance Kid”

HEAT is made up of top level law enforcement professionals from the DOJ and HHS, and are dedicated to enabling joint efforts all across government to both prevent fraud and enforce current anti-fraud laws around the country. They have, evidently, lots of financing, manpower and… well… power.

The HEAT team meets bi-weekly, and has been expanded to four major cities: South Florida, Los Angeles, Detroit and Houston. They use state-of-the-art, cutting edge technology to identify and analyze potential fraud with great speed and efficiency, now completing analysis of electronic evidence in a matter of days, instead of what previously took months to complete using more traditional investigative tools. HEAT is also tasked with expanding the CMS Medicaid provider audit programs, to help State Medicaid officials conduct audits, monitor activities and detect fraud. In other words, they’re everywhere.

ALSO, they appear to be providing new and additional funding to assist and expand the use of the Medicare Drug Integrity contractors, who monitor Medicare Parts C & D compliance and enforcement.

Readers might recall that the President’s 2010 budget for HHS contained funding for anti-fraud efforts, and all those efforts were expected to save $2.7 billion.

In five years.

The above settlement was for $2.3 billion.

Our math says they shouldn’t have any trouble reaching that goal by, what, next month? Remember also that the RAC Demonstration project found $300 Million in just the first 3 months it was operating, and the HEAT has far more reach that even the first RACs in the Demonstration project.

Read our news article and get the original DOJ press release HERE.

Click HERE to read more background on HEAT.

Take 2 Tylenol, then click HERE to find out what HEAT is doing in YOUR state.

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Tags: healthcare fraud, healthcare fraud prevention and enforcement action team, healthcare reform, HEAT, rac, recovery audit contractor

This entry was posted on Tuesday, September 29th, 2009 at 2:33 pm and is filed under From the road..., Medical Coding News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.