
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SATURDAY, June 12, 1993                   TAG: 9306120158
SECTION: VIRGINIA                    PAGE: C2   EDITION: STATE 
SOURCE: Associated Press
DATELINE: RICHMOND                                LENGTH: Medium

GOVERNMENTS JOIN FORCES TO FIGHT HEALTH-CARE FRAUD

Virginia's attorney general and the federal prosecutor for the state's Eastern District said Friday they will join forces for a three-pronged attack on health-care fraud in the state.

Attorney General Stephen D. Rosenthal and U.S. Attorney Kenneth E. Melson said the initiative is the first of its kind in the nation.

The program includes:

A federal-state pilot program in which the offices of state attorney general and U.S. attorney will combat medical fraud.

An Affirmative Civil Enforcement program in the U.S. attorney's office for all federal health-care programs.

A criminal task force for health-care fraud cases.

About 10 percent of the nation's annual $1 trillion in health-care expenditures is fraudulent, Rosenthal said.

"Our joint efforts will root out one of the most insidious forms of crime - white-collar professionals who deviously bill for medical services never performed on patients participating in government-sponsored programs such as Medicaid," Rosenthal said.

Melson said law enforcement agencies serve the public best when they combine resources.

"We've got to send a clear message to those who seek to bilk federal dollars at taxpayer expense: You will be prosecuted to the fullest measure the law permits," Melson said.

The first aspect of the initiative, the pilot program, will increase government scrutiny of Medicaid claims. Melson's office will pursue criminal charges and civil lawsuits in federal court, and the attorney general's staff will be authorized to prosecute in federal court as well as state court.

Federal law allows the government to recover three times the amount of money lost in a fraudulent claim, plus a civil penalty of $5,000 to $10,000 for each false statement submitted to any state or federal agency. Money recovered will be split between the state and federal governments.

Also, any criminal violations uncovered by the pilot program could result in jail or prison sentences.

The Affirmative Civil Enforcement program will target fraud in federal health-care programs other than Medicaid. It will focus on cases involving psychiatric hospitals, mobile laboratories, national laboratories and drug companies.

The criminal task force will investigate suspected violations of general fraud statutes, including those dealing with false claims, false certification, kickbacks, wire fraud and mail fraud.

by CNB