Sunday, September 29, 2013

What Government Shut Down Really Mean -------------------

To all brethren good Citizens,

President Obama had a vision which he shared and got full public support and mandate. The vision that are good, fair and balanced for all people. The President is paying the price for the promise he made to save people’s lives with economic collapse.The President promised to serve diligently without veering off into the convoluted plot twists with unnecessary melodrama that afflicted so many people with economic downturn and loss of job opportunities. The country’s economy suffered from budget deficits over the years, a situation created by special business interest who evaded paying taxes and equally defaulted in paying back Government loans on time. There were many other instances of business theft that went on for many years undetected including twisted bankruptcy where businesses shut-down, with instances of irregular ponzi-schemes and Hedge Funding that were reasons that added to serious budget deficits by the selfish and greedy special interest group.

To suspend Obamacare for another year is a crime against the people on their medical security. To protect from further medical fraud, the program must commence on time as legislated.

It must be known that, once a federal law has been enforced, it remain a validated law of the land. It is a requirement by law that the Presidency must be respected by all irrespectively. Knowing that President being in-charge of the executive branch, and that the Obamacare having gone through checks and balances in the normal legal dispensation process without a hitch; it is a crime, illegal and contemptuous for any group of politicians or the Speaker to change its course to allow Government Shut-down that serve fundamental public interest to favor special interest of a few, is unacceptable. It is as well breaking the law of many to short-change in ways or form, to bring such matter to be a subject for discussion. Delaying or suspending healthcare for people is deninately a crime that must be disputed by all to protect health security concerns; and politics must not be allowed to interfere with peoples livelihood and health interests.

How does this Gov. Shut-down impact debt default, when the nation's borrowing go double from default and the limit must be raised from default? How will this help the Government from not defaulting???Does it not mean that these politicians who are after the Government Shut Down are into a jig-saw-cut-deal for their self and greedy interest, and that they are trading short-change business by using Gov. Shut-down purposefully to push Government to default to benefit benefactors? How can people trust Ted Cruz with those behind him pushing for the same??? This is definately a tango to test President Obama ability to leadership. Who will President Obama support, the people or the special interest??? Law is Law and no one is above the law. Obamacare is legally binding and it remains the law. This is the feel President Obama should guard against political actions that are in contempt of the law. This is asking the President to compromise on what is the this right??? Is this what the American people want???

It is unthinkable and despicable that a few special interest Republicans behave this way in a selfish manner to disrepute and embarrass this great Nation on the face of the world. Business community as well have a duty to respect the law.

It is therefore our concern and rights that we the people engage public support to reject the motion of Government-Shut-Down and petition the President to oppose this bad melodrama and instead, use his prerogative to save this ugly situation for the sake of many and equally protect democracy on fundamental service to the people. In these instances and for the sake of security of majority people and the Nation, President Obama has right to use the obligated power vested for the Presidency to VETO any such proceedings to save a situation.

Judy Miriga
Diaspora Spokesperson &
Executive Director for
Confederation Council Foundation for Africa


What ObamaCare Will Mean for You

Published on Sep 27, 2013 and use the new Health Insurance Marketplace to see all of the health plans available in your area and sign up for the one that fits your needs and budget. You can also find out if you're eligible to pay less for private health insurance or whether you qualify for other free or low-cost programs.

White House White Board: What Obamacare Means for You

Megan SlackMegan Slack
September 27, 2013
11:01 AM EDT
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The Affordable Care Act - also known as Obamacare - means better coverage for those who already have health insurance, and more options for those who don’t, including a new way to shop for affordable, high-quality coverage.
Watch the latest White House White Board to learn more about what the law means for you.
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To Ask China's Permission First

English: Ted Cruz at the Republican Leadership...
Ted Cruz: Has he overplayed his hand? (Photo credit: Wikipedia)
Ted Cruz, an ultra-conservative Cuban American who is leading the current assault on Obamacare, has done more than anybody to bring the federal government to the brink of shutdown. What he has not considered is how America’s foreign creditors will react.
Although China, Japan, and other major creditor nations have no dog in the Obamacare fight, they have a strong interest in preserving America’s basic financial, economic, and social stability. From their point of view, Cruz, a junior senator from Texas and a Tea Party favorite, is not following the script. It is essential that he be smacked down – and he will.
Bruce JapsenContributor
Unbeknownst to Cruz, and seemingly to most of the rest of the Republican party, the creditor nations hold the high cards. If they were to sell just a small proportion of their American assets, they could send Wall Street into a tailspin. They are unlikely to do this but even if they were merely to slow the pace of their buying, bond yields would rocket and stocks could fall 15 percent in the space of a couple of weeks.
It is sometimes suggested that by triggering a sell-off, creditor nations would be cutting their own throats. Actually this is a characteristically myopic Western way of looking at things – a view that completely misunderstands how things have changed now that East Asians call the tune. The point is that the creditor nations are long-term holders who are largely indifferent to short-term fluctuations.
As a general rule, the East Asian creditor nations hate drawing attention to themselves. But they are quite effective behind the scenes in making their views known. One of the most important ways they wield influence is through major Wall Street investment banks. These latter in turn spend large amounts on political contributions, typically backing both Republicans and Democrats. Their money gives them plenty of face time to advise American elected representatives on “good economics,” a term that more and more these days amounts to economics that serves East Asia’s interests. Meanwhile American investors generally are short-term thinkers who rarely show much intestinal fortitude in riding out downturns. As they generally vote Republican, their bleating can be expected to help soften the attitudes of Cruz and his cohorts.
It remains to be seen how markets will react tomorrow but the betting is that, in the absence of a climbdown by Republicans, we will see a significant correction. And if Cruz and his allies continue to stick by their guns in the weeks ahead, we could see damage particularly in techs and other high P/E stocks. For the record, major tech stocks that seem most richly valued on a forward P/E basis include CRM, LNKD, CCI, FB, and ADBE. Although future prospects may justify such valuations, the short-term action could be quite bumpy — certainly bumpy enough to frighten a lot of the Republican rank and file.

Jake Miller /
CBS News/ September 22, 2013, 4:29 PM

Budget bill battle over Obamacare opens new GOP schism

Sen. Ted Cruz, R-Texas, center, smiles during a news conference with conservative Congressional Republicans who persuaded the House leadership to include defunding the Affordable Care Act as part of legislation to prevent a government shutdown, at the Capitol in Washington, Thursday, Sept. 19, 2013.
Sen. Ted Cruz, R-Texas, center, smiles during a news conference with conservative Congressional Republicans who persuaded the House leadership to include defunding the Affordable Care Act as part of legislation to prevent a government shutdown, at the Capitol in Washington, Thursday, Sept. 19, 2013. / AP Photo/J. Scott Applewhite
After the House passed a bill on Friday funding the government for roughly three months but defunding Obamacare, the fight over the budget and the healthcare law shifted to the Senate.
While most lawmakers, including many Republicans, have all but conceded that the Senate will never pass the House bill and will instead re-insert Obamacare funding, Sen. Ted Cruz, R-Texas, who is leading the fight against the healthcare law in the upper chamber, insisted it's still possible for the Senate to follow the House's lead.
"Senate Republicans should stand united to stop [Senate Majority Leader] Harry Reid from changing the House bill and, in particular, from inserting the funding from Obamacare with 51 votes," said Cruz on "Fox News Sunday." "That's going to be the fight procedurally - whether he's able to use a straight party line vote, just Democrats, to put Obamacare back. And you know what? If Senate Republicans stand together, we can stop Harry Reid from doing it."
Cruz said he will ask Reid to institute a 60-vote threshold for amendments to the House bill, which would enable the Senate's 46 Republicans to block any measure re-inserting Obamacare funding if they are able to stand united.

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Rep. Salmon: Defunding Obamacare "the will of the people"

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Coburn: "We don't have the ability" to defund Obamacare

But when he was pressed by Fox News' Chris Wallace on whether his GOP colleagues will stand behind him, the Texas Republican demurred.
"We don't know right now, and this week, we'll determine that," he said. "Look, this has been a fast moving target. You know, just a few weeks ago, we didn't have any of the votes we needed in the House or in the Senate."
If he doesn't get his wish, and the Senate votes to send a bill with Obamacare funding back to the House, Cruz said Republicans should stand strong, even if it means incurring a government shutdown - not that such a result would be the fault of the GOP.
"I believe we should stand our ground and I don't think Harry Reid and Barack Obama should shut down the federal government," he said. "Look, the House voted to fund the federal government. If Harry Reid kills that, Harry Reid is responsible for shutting down the government and he should listen to the American people, open the government, fund the government, but don't fund Obamacare because it's hurting the American people."
Despite Cruz's tough talk, most of the rest of Washington is convinced his push to defund Obamacare will ultimately come up short. And some of the strongest notes of skepticism are coming from his fellow Republicans.
"I am sure the Senate is going to move that bill forward," said Sen. Tom Coburn, R-Okla., on CBS' "Face the Nation. "We don't have the ability... to put a total stop and defund Obamacare. It would be nice if we did. I'd be in the fight."
Coburn marveled that those who were clamoring loudest for a vote on defunding Obamacare, such as Cruz, are now threatening to halt the legislative the process if it doesn't suit their ends. "The ironic that the answer now in the Senate, by those who proposed this strategy, is to filibuster the very bill they said they wanted," he said.
Even Sen. Rand Paul, R-Ky., who has sided with Cruz and other Republicans pushing to defund the law, threw cold water on the likelihood that they could succeed.
"We probably can't defeat or get rid of Obamacare," Paul told reporters at a Republican gathering on Saturday, according to the Associated Press.
The skepticism from Paul and Coburn echoed that of other Republicans, such as Sen. John McCain, R-Ariz., who said this week that it's not "rational" for Republicans to think they can defund the healthcare law during the budget fight, and Rep. Peter King, R-N.Y., who urged Cruz to "keep quiet" with his hard-line on Obamacare.
Democrats, for their part, agree with their GOP colleagues who believe that de-funding the healthcare law is off the table. Senate Majority Leader Harry Reid, D-Nev., has vowed that any bill that touches Obamacare funding is "dead" when it reaches his chamber.

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Reid: "Any bill that defunds Obamacare is dead"

In the meantime, though, Democrats are happy to sit back and watch Republicans snipe at each other, saying the infighting demonstrates just how disorganized and ideologically bankrupt the GOP has become.
"Let's be really clear about this: The Republicans put legislation on the floor that was intended to shut down government. For them, that's a victory, because they're anti-government ideologues who dominate the Republican Party," said House Minority Leader Nancy Pelosi, D-Calif., Sunday on CNN. "The effect of putting the Affordable Care Act on the bill is to shut down government. They know that. They know that has no prospect of prevailing."
"I call them legislative arsonists," she continued, warning that Republicans' obsession with Obamacare could wreak havoc on other, unrelated budget items. "They're there to burn down what we should be building up in terms of investments and education and scientific research and all that it is that make our country great and competitive. I don't paint them all with the same brush. And I certainly don't paint the speaker with that brush. But enough of them in their caucus to shut down government. That would be a victory for them."
Sen. Claire McCaskill, D-Mo., told "Fox News Sunday" that Republicans are throwing a "tantrum" because they didn't get their way in the 2012 election.
"It's not brute political force that is refusing to defund Obamacare. It's called the American people and elections. I don't think in America, we should throw tantrums when we lose elections and threaten to shut down the government and refuse to pay the bills," she said. "I cannot believe that they are going to throw a tantrum and throw the American people and our economic recovery under the bus."
Unfortunately, partisan dan doesn't quite understand that both parties spend our money equally -- they just have different priorities -- and the PPACA fixed the Medicare Part D "donut hole" that saves seniors billions, since the PPACA funded the unfunded GOP legislation!

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jimsmith90210 says:
Quite hypocritical of rafael cruz, the Canadian senator living in texas, to be filibustering "until he can no longer stand" in the Senate, while 26% of his constitutents lack health care -- the state with the most uninsured and under-insured residents -- which only means he should be championing the ACA instead of fighting it!
Au contraire!!!It's different for the GOP than the Democrats. Things that are okay for the GOP are an outrage when Democrats do them. If Obama was born in the United States, as was his mother, but his father was born in Kenya, that makes him not a US citizen. But if Cruz's mother was born in the United States, and he was born in a foreign country, that makes him a US citizen. Kind of like how Romneycare is good, but Obamacare is bad. Or how Obama should be forced to make every single school record public, but Romney's tax returns were nobody else's business. Or how Anthony Weiner is a horrible, morally corrupt man (he is) but Mark Sanford was such a paragon of virtue that he not only was allowed to finish his term in the House, but then went on to be elected to the Senate. How silly of you, thinking that the GOP should operate under the same rules. I hope you understand now, how absurd the very suggestion is.

jimsmith90210 says:
ButIPlay1onTV says: "Now notice that Cruz is still a Canuck. At least, after he's run out of congress and exiled back to his home country, he'll get their free healthcare."

Maybe not, since the Canadians could agree to take him back on the condition that he will not apply for socialized health care since he is so radically against it, and force him to return to texas for health care - the state that has the highest number of uninsured residents!

goldenrod25 says:
Strange how the Republicans keep fighting amongst themselves. Seems like McConnell finally grew a pair and put Cruz in his place. Too bad Boehner doesn't do the same to the TeaParty nuts in the House.

House Republicans defy Obama on funding bill; government shutdown nears

Thomas Ferraro and Richard Cowan 2 hours ago

McCarthy walks to the House floor for a series of late-night votes Saturday session at the U.S. Capitol in Washington

By Thomas Ferraro and Richard Cowan
WASHINGTON (Reuters) - The House of Representatives early on Sunday brought the federal government closer to a shutdown as it voted to delay President Barack Obama's landmark healthcare law for a year as part of an emergency spending bill.
By a mostly partisan vote of 231-192, the Republican-controlled House approved the "Obamacare" amendment, despite a veto threat from the White House.
It also voted 248-174 to repeal a medical device tax that aims to help fund healthcare programs under the 2010 law.
And in a sign that lawmakers might be resigned to a government shutdown beginning Tuesday, the House unanimously approved a bill to keep paying U.S. soldiers in the event the government runs out of money to run many programs.
Senate Majority Leader Harry Reid reiterated on Saturday that the House bill would be dead on arrival in the Democratic-controlled Senate, which is not scheduled to meet until 2 p.m. on Monday.
Obama also threatened to veto any bill that delays his healthcare restructuring.
There is a slight chance the two sides could reach a funding deal before the government's fiscal year ends at midnight on Monday. Congress could also act at any time to end the impasse if a shutdown did occur.
But the bitterness of the House debate on Saturday night that spilled into early Sunday did not bode well for prospects of a compromise.
"You have been hijacked by a group called the Tea Party," Democratic Representative David Scott of Georgia said angrily, referring to the powerful conservative, anti-government movement that holds significant sway over Republicans.
"The American people deserve to have time to see what this monstrosity will do before it is implemented," shouted Republican Representative John Culberson of Texas, referring to "Obamacare."
The high-stakes maneuvering between Democrats and Republicans is likely to continue through much of Monday.
The standoff is also a harbinger for the next big political battle in Washington: a far more consequential bill to raise the federal government's borrowing authority. Failure to raise the debt ceiling by mid-October could result in the government defaulting on its obligations.
The funding impasse is the culmination of more than three years of failed conservative efforts to repeal "Obamacare," a program aimed at extending health insurance to millions of those without coverage.
Republicans argue that "Obamacare," which is set to launch on October 1, is a massive and unnecessary government intrusion into medicine that will cause premiums to skyrocket and damage the economy.
Failure to pass a funding bill would close down much of the government for the first time since 1996. More than a million federal employees would be furloughed from their jobs, with the impact depending on the duration of a shutdown.
The current timetable could leave House Speaker John Boehner with the most difficult decision of his career: whether to approve a straight-forward spending bill passed on Friday by the Senate or allow the government shutdown to begin.
Neither side wants to be the last to cast the final vote that would lead to a shutdown, a concern that has turned the funding measure into a hot potato tossed between the two chambers.
While polls consistently show the American public is tired of political showdowns and opposed to a shutdown, House conservatives were jubilant about the fight.
"This is a win-win all the way around," said Republican Arizona Representative Matt Salmon, who described the mood of Republicans before the vote as "ecstatic."
Republicans and a handful of Democrats also approved an amendment to the bill repealing a tax on medical devices that helps fund the healthcare law to the tune of about $30 billion. That provision, sought with heavy lobbying by the medical device industry, has been supported in the past by some Democratic senators.
In a government shutdown, spending for functions considered essential, related to national security or public safety, would continue along with benefit programs such as Medicare health insurance and Social Security retirement benefits for seniors.
But civilian federal employees - from people who process forms and handle regulatory proceedings to workers at national parks and museums in Washington - would be temporarily out of work.
The last government shutdown ran from December 16, 1995 to January 6, 1996, and was the product of a budget battle between Democratic President Bill Clinton and Republicans, led by then-Speaker Newt Gingrich.
Republicans suffered a public backlash when voters re-elected Clinton in a landslide the following November, a lesson never forgotten by senior Republicans, including Boehner.
This time, Boehner tried to avoid a showdown but was overruled by his rebellious caucus, largely influenced since the 2010 election by newcomers endorsed by the Tea Party.
While Boehner and Majority Leader Eric Cantor, the top House Republicans, worked behind the scenes, they did not deliver floor speeches in support of the bill - something they often do on major legislation.
Instead, some of the House's most conservative members who drove the "Obamacare" delay effort, dominated the debate.
With Boehner effectively sidelined, rank-and-file Republicans boasted of their unity. Members chanted, "Vote, vote, vote, vote," in their closed-door meeting, they reported later.
Afterward, Democratic Representative Louise Slaughter of New York, took to the House floor to accuse Republicans of throwing a "temper tantrum" about "Obamacare" under pressure from "Tea Party extremists."
Conservative and liberal groups, from the Tea Party to women's rights organizations, have been cashing in on the showdown over "Obamacare," using it to rally supporters and raise money for next year's congressional elections.
(Additional reporting by Caren Bohan and Kim Dixon.; Editing by Fred Barbash, Christopher Wilson and Paul Simao)

Bill Clinton: When It Comes to Obamacare, GOP 'Begging for America to Fail'

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.abc bill clinton jtm 130926 16x9 608 Bill Clinton: When It Comes to Obamacare, GOP Begging for America to Fail
The Republican Party is "begging for America to fail" by rooting for President Obama's signature health care law to fail, former President Bill Clinton said during an interview for "This Week" with ABC's George Stephanopoulos,
"I've never seen a time - can you remember a time in your lifetime when a major political party was just sitting around, begging for America to fail … I don't know what's going to happen. But I'll be shocked if it fails," Clinton, who attempted during his first term as president to overhaul the country's healthcare system in the early 1990s, said during an interview taped Thursday in New York while the annual Clinton Global Initiative was taking place.
A recent ABC News-Washington Post-poll found that more than half of Americans are opposed to the Affordable Care Act. But for his part, Clinton is optimistic that with time, the law - known more commonly as "Obamacare" - will grow in popularity.
"I just think that when all these dire predictions don't come out, if they don't - I believe that pretty soon, within the next several years, this'll be like Medicare and Medicaid. And it'll be a normal part of our life. And people will be glad it's there," the former president told ABC News.
Clinton was responding to a recent suggestion by Republican South Carolina Sen. Lindsey Graham that former Secretary of State Hillary Clinton's political future was tied to the success or failure of Obamacare. Graham said he thinks the law will fail.
Clinton told Stephanopoulos he was "not at all" concerned about the potential failure of the Affordable Care Act having any impact on a potential run by his wife for the White House in 2016.
"I think this bill's already produced a lot of good results and every - look, they are desperate for this bill to fail, because if it's not a failure, their whole - everything they've been telling us since 1980 that government's bad is wrong. They so badly want it to fail," he said.
Since being passed in 2010, the Affordable Care Act has been a political lightning rod and has been subject to attempts by Republicans to delay and defund it. The law is at the center of the current fight in Congress that could lead to a government shutdown, which would be the first in almost 20 years.
Like "This Week" on Facebook . You can also follow the show on Twitter.
Go here to find out when "This Week" is on in your area.

Example for Heads-up, Please take note:

Healthcare Fraud - Criminal Investigation (CI)


Criminal Investigation investigates healthcare fraud perpetrated against the federal and state governments, as well as private insurance companies. In these investigations, CI follows the money trail and considers both tax and money laundering perspectives. Criminal tax investigations are initiated when income generated from healthcare fraud is not correctly reported on tax returns, or when there is an overstatement of expenses on tax returns. Criminal Investigation investigates money laundering when either illegally obtained funds from healthcare fraud are used to purchase assets or when the perpetrators of the schemes devise elaborate methods to conceal their fraudulent proceeds. Money laundering occurs in a wide range of fraudulent healthcare schemes such as false claims, kickbacks, or staged accidents.
Typical healthcare fraud investigations are lengthy, labor intensive, and involve complex issues. To assist in combating healthcare fraud, CI participates in DOJ-sponsored, multi-agency task forces and works closely with several state agencies. These task forces capitalize on the strength and expertise of the participating agencies and have proven effective in dealing with healthcare fraud.
Criminal Investigation’s participation enhances multi-agency healthcare fraud investigations by documenting that the perpetrators of these schemes financially benefited from their fraudulent activities. Currently, CI is involved in the following areas of healthcare fraud: false billings, mental health, nursing home fraud, chiropractic fraud, durable medical equipment fraud, staged accidents, pharmaceutical diversion, and patient referral (kickbacks) schemes.
Statistical Data
Healthcare Fraud enforcement statistics on investigations initiated, prosecutions recommended, indictments, sentenced investigations and months to serve in prison.
Examples of Healthcare Fraud Investigations
Examples of investigations have been written from public record documents filed in the district courts where the case was prosecuted.


June 1st, 2011

Undercover Investigation Reveals Unfair Treatment of Dental Patients

According to the findings of an undercover investigation, dentists overcharge their patients and do not inform them correctly regarding the fact that they can get cheaper treatments through their NHS policies

According to the findings of an undercover investigation, dentists overcharge their patients and do not inform them correctly regarding the fact that they can get cheaper treatments through their NHS policies.
Some even go to the point where they pressure the patients to choose the private insurance, even though these patients could receive the same quality treatment through NHS, but much more cheaply.
There has also been a case where a patient received a quote 4 times more expensive than a non-private insurance quote for a root canal treatment.
These findings have been made public through the “Dispatches” team from Channel for on TV. There have even been sent out members from the public to go for NHS check-up at offices that offer both private and non-private treatments.
After the “patients” have spent on an average 15 minutes inside the office, they came out and said that they have been recommended to go with private care (the focus has been especially on hygienic dental services). An NHS scale and polish treatment costs around £16.50, but instead of that patients have been given quotes for private treatment which is much more expensive.
Some other members of the public were sent to three surgeries where they have been asking about the root canal treatment options.
With the NHS this treatment costs around £198, but instead patients have been quoted rates coming from the private sphere- £678, £598 and £725 respectively.
The opinion of Dr. Anthony Halperin who is a dentist and a member of the Patients Association is that these dentists are not sincere and rightful towards their patients.
The next step is that the coalition is ready to re-negotiate the dentistry deal of the Labour from 2006, to see what changes can be made in order to enforce fair treatment for the patients in the dentistry field.

Health Care Fraud
Trends and Tips
06/28/10 Prescription pills

A pharmaceutical company marketed four drugs to doctors. The drugs had been approved by the Food and Drug Administration (FDA) for specific medical conditions—like rheumatoid arthritis, schizophrenia, and neuropathic pain—but the company promoted the drugs for other uses as well—like post-operative pain, dementia, and migraines—and sometimes in larger doses than the FDA allowed. In some cases, the company even paid kickbacks to doctors to prescribe the drugs for these other uses.
What this company did is known as off-label marketing of prescription drugs, and it’s both illegal and potentially harmful to consumers. After an investigation involving the FBI and our federal and state partners, the company pled guilty to misbranding the drugs and agreed to pay $2.3 billion to settle criminal and civil violations…the largest U.S. health care fraud settlement ever.
At the FBI, we take our health care fraud responsibilities seriously as the primary investigative agency with jurisdiction over both federal and private insurance programs. But with total health care expenditures in the U.S. expected to reach $2.26 trillion by 2016 according to the Centers for Medicare and Medicaid Services, the opportunity for fraud will continue to grow—so will our workload. That means we have to find ways to leverage our resources.
Latest Schemes and Scams
As part of its health care fraud program, the Bureau is looking at various fraud schemes involving:

- Home health care;
- Infusion therapy; and
- Durable medical equipment.

We’re also focused on other health care fraud-related crime problems impacting public safety, such as:

- Off-label marketing of prescription drugs;
- Drug diversion (prescription drugs diverted from legitimate supply sources for illicit distribution and abuse); and
- Internet pharmacies
Partnerships are key. A tried-and-true method of leveraging resources is establishing partnerships. And we’ve done just that—with federal agencies like the FDA and the Drug Enforcement Administration, various state and local agencies, and private insurance groups like the National Health Care Anti-Fraud Association.
Our most recent joint endeavor? Our participation in the Department of Justice/Health and Human Services’ (HHS) Health Care Fraud Prevention and Enforcement Action Team, or HEAT, and its Medicare Fraud Strike Forces located in several major metropolitan areas.
The HEAT initiative includes senior Justice, FBI, and HHS officials who are focusing their efforts to reduce Medicare and Medicaid fraud through enhanced cooperation. And the strike forces, which use a data-driven approach to identify unexplainable billing patterns by health care providers and then investigate these providers for possible fraudulent activity, are a vital part of the initiative. As a result of strike force efforts, more than 300 cases have been filed and close to 600 defendants charged.
Health care fraud facts:
  • Health care fraud schemes come in all forms—fraudulent billings, medically unnecessary services or prescriptions, kickbacks, duplicate claims, etc.
  • Schemes target large health care programs—both public and private—as well as health care beneficiaries. (Medicare and the Medicaid are the largest programs, so they are targeted more often.)
  • Schemes are committed by health care providers, owners of medical facilities and laboratories, suppliers of medical equipment, organized crime groups, corporations, and even sometimes by the beneficiaries themselves.
  • FBI health care fraud cases sometimes cross over into other investigative areas, like organized crime, gangs, and cyber crime, where we see criminals beginning to use the proceeds from health care fraud schemes to fund their operations.
Tips to help avoid being victimized:
  • Protect your health insurance information card like a credit card.
  • Beware of free health services—are they too good to be true?
  • Review your medical bills, like your “explanation of benefits,” after receiving health care services and ensure the dates are services are correct.
And if you suspect health care fraud, contact your local FBI office.

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