Crackdown on Fraud and Abuse in Detroit, Miami Signals Health Care Reform as a Priority of the Obama Administration

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Federal agents arrested dozens of people in Miami and Detroit yesterday morning for allegedly submitting Medicare claims totaling $50 million for treatments that were unneeded and sometimes never provided, according to The Washington Post.

Later in the day, the Justice Department unsealed criminal indictments against 53 people in connection with the arrests. In Detroit, the indictments focus on costly HIV/AIDS infusion drugs as well as physical and occupational therapy treatments.

According to The Post,

Authorities filed criminal charges against patients, doctors, medical assistants and company owners who allegedly played complicit roles in the fraud schemes. Prosecutors are seeking forfeiture of the criminal proceeds and restitution to the Medicare program.

The action was announced at a news conference held by Attorney General Eric H. Holder Jr., Health and Human Services Director Kathleen Sebelius, and FBI Director Robert S. Mueller III.

We will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health-care costs,

said Attorney General Holder.

Savings Generated From Reducing Hospital Readmissions Could Help Cover the Uninsured

Hospital readmissions cost the U.S. billions of dollars a year, yet many can be prevented with better follow-up care, according to a study published Wednesday in the New England Journal of Medicine.

According to the study,

As many as a fifth all Medicare patients are readmitted within a month of being discharged . . . and a third are rehospitalized within 90 days.

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We recently reported that a pilot program in Baton Rouge and 13 other cities seeks to reduce the number of chronically ill elderly that are readmitted to the hospital. That program, called the Care Transitions Project, provides patients with a “transition coach” who helps them recognize symptoms and create a plan for follow-up care.

The New York Times reports that the Obama administration has already identified hospital readmissions as a potential source of cost-cutting. Hospitals with high numbers of patients who are readmitted would receive lowered payments under the president’s budget, which calls for $26 billion in savings from reducing readmissions over 10 years.

Policy analysts say that insurers, including Medicare, must begin to reward doctors and hospitals that help patients get better and stay healthy. While some hospitals have already shown that they can reduce readmissions by taking simple steps, about one in four of the nation’s hospitals derive 25% of their admissions from returning patients.