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Date: May 3, 1995
FOR IMMEDIATE RELEASE 
Contact: HHS Press Office, HCFA (202) 690-6343

The targeted anti-fraud project, known as "Operation Restore Trust," will initially focus on five states -- New York, Florida, Illinois, Texas, and California -- that have nearly 40 percent of all Medicare and Medicaid beneficiaries.

The President made the announcement to delegates at the White House Conference on Aging.

"One area where we can all agree is the importance of maintaining the nation's health safety net, Medicare and Medicaid, and that means taking strong measures to ensure that these programs are as efficient as possible," said HHS Secretary Donna E. Shalala.

Savings will include court awards in fraud cases and decreased up-front billings for fraudulent and wasteful practices.

"'Operation Restore Trust' will be a win-win for everybody except those who try to cheat the system," Secretary Shalala said. "For every dollar we spend on this program, the Medicare and Medicaid programs will save six to eight dollars in reduced spending on wasteful practices and court awards from fraud cases."

In addition to identifying and penalizing those who willingly defraud the government, the project is designed to alert the public and industry to the fraud schemes. The project will also help identify and correct the vulnerabilities in the Medicare and Medicaid programs.

A voluntary disclosure program included in the project will allow companies to come forward with evidence of fraud or errors within their own organizations, in consideration for possible reduced penalties.

The HHS Office of Inspector General (OIG), the Health Care Financing Administration (HCFA) and the Administration on Aging will be partners in "Operation Restore Trust." The project will also involve an intergovernmental team comprised of federal and state personnel.

Shalala said participation by the public, including Medicare and Medicaid beneficiaries, as well as the medical providers in the private sector will be crucial to the project. Later this month, HHS will establish a special hot-line for fraud and waste reports by the public.

"We need to weave fraud control deeper into the fabric of our programs, and we need our beneficiaries and our private sector partners to help us," Shalala said.

Recent reports and investigations by the OIG and special program initiatives by HCFA have shown that home health care and nursing facilities are particularly susceptible to fraud and abuse.

In the home health industry, this fraud has included billing for excessive services or for services not rendered, the use of unlicensed or untrained staff, falsified plans of care, forged physician signatures, and kickbacks.

"We have found significant evidence of inappropriate payments and overuse of services in nursing homes, which means not only the loss of money to the Medicare program, but also a financial burden on beneficiaries," said HHS Inspector General June Gibbs Brown.

Suppliers of durable medical equipment (DME) are also implicated in many of the abuses identified.

"In a time of fiscal austerity, this project is a mechanism that increases our capacity to combat health care fraud and abuse," said HCFA Administrator Bruce C. Vladeck. "It's a smart investment that will save money for the government and the taxpayer, and can mean lower health care costs for beneficiaries as well."

Note: Fact sheets are available from the HHS Press Office, (202) 690-6343