Health Care Fraud and Abuse Control Program ,,,,,,REALLY?

By Jim Kouri

The Department of Justice, in cooperation with the Department of Health and Human Services, has guided the enforcement efforts of the national Health Care Fraud and Abuse Control Program (HCFAC) since its inception in 1997.

The program was designed to coordinate federal, state and local law enforcement on cases of health care fraud and abuse as part of the Health Insurance Portability and Accountability Act (HIPAA).

In 2008, the Department’s efforts to investigate and prosecute the individuals and companies who commit health care fraud are as strong as ever, thanks in large part to the Department’s many components working closely with partners at the Department of Health and Human Services, and state and local law enforcement.

Strengthening Criminal Enforcement:

In recent years, the Department has stepped up its enforcement efforts related to health care fraud, including the following accomplishments in Fiscal Year 2007:

– U.S. Attorneys’ Offices opened 878 new criminal health care fraud investigations involving 1,548 potential defendants.

– Federal prosecutors had 1,612 health care fraud criminal investigations pending, involving 2,603 potential defendants, and filed criminal charges in 434 cases involving 786 defendants.

– A total of 560 defendants were convicted for health care fraud-related crimes during the year.


– In one of the most recent enforcement actions, on May 21, 2008, Jorge Alan Rodriguez Sanchez was indicted in the Eastern District of Pennsylvania for conspiring to distribute Schedule II controlled substances illegally through an Internet pharmacy.

Beginning in 2002, Rodriguez Sanchez allegedly sold via e-mail narcotic prescription drugs, such as Oxycontin, Vicodin and Xanax to customers without prescription or legitimate medical use. Rodriguez Sanchez did not require a prescription or physical examination by a licensed physician from any of his customers. He retrieved the money sent by the customers at a Western Union location in Mexico, but shipped the drugs from Southern California to customers throughout the United States, including the Philadelphia area.

– During FY 2007, the Department opened 776 new civil health care fraud investigations, and had 743 civil health care fraud investigations pending at the end of the fiscal year.

– During FY 2007, the federal government won or negotiated approximately $1.8 billion in judgments and settlements, and it attained additional administrative impositions in health care fraud cases and proceedings.

– The Medicare Trust Fund received transfers of approximately $797 million during this period as a result of these efforts, as well as those of preceding years, in addition to $266 million in federal Medicaid money separately transferred to the Treasury as a result of these efforts. Some recent civil enforcement actions include:


(This article is a consolidation of information received by the 14,000-member National Association of Chiefs of Police’s Fraud Investigation Committee.)

Jim Kouri, CPP is currently fifth vice-president of the National Association of Chiefs of Police and he’s a staff writer for the New Media Alliance (thenma.org). In addition, he’s the new editor for the House Conservatives Fund’s weblog. Kouri also serves as political advisor for Emmy and Golden Globe winning actor Michael Moriarty.

He’s former chief at a New York City housing project in Washington Heights nicknamed “Crack City” by reporters covering the drug war in the 1980s. In addition, he served as director of public safety at a New Jersey university and director of security for several major organizations. He’s also served on the National Drug Task Force and trained police and security officers throughout the country. Kouri writes for many police and security magazines including Chief of Police, Police Times, The Narc Officer and others. He’s a news writer for TheConservativeVoice.Com and PHXnews.com. He’s also a columnist for AmericanDaily.Com, MensNewsDaily.Com, MichNews.Com, and he’s syndicated by AXcessNews.Com. He’s appeared as on-air commentator for over 100 TV and radio news and talk shows including Oprah, McLaughlin Report, CNN Headline News, MTV, Fox News, etc. His book Assume The Position is available at Amazon.Com. Kouri’s own website is located at http://jimkouri.us