And prosecution of individuals, as was done at Maxim, is likely to serve as the best deterrent, said Thacker at the Project on Government Oversight.

He also said another increasingly common prosecutorial tactic is barring individuals — even chief executives — from doing business with the programs they cheated. That step is now being taken in lieu of barring entire companies.

Kusserow noted that individuals convicted of criminal offenses are automatically barred from billing government programs, but not those who settle civil claims. He also said that increased scrutiny and fines "can really hurt a lot."

Government inspectors, who gained $250 million in funding through the federal health care reform law, are stepping up their enforcement of health care waste, fraud and abuse, Kusserow said. Programs like Medicare and Medicaid are using the money to hire contractors that act like "bounty hunters" who use sophisticated computer programs to search for cheaters.

That is likely to increase the number of fraud cases in the short term. Already, the watchdog group Taxpayers against Fraud reports that health care fraud accounts for 80 percent of the cases filed under the federal False Claims Act.

States with their own laws "earn a seat at the table during settlement negotiations" in cases initiated by federal law enforcers, said Thomas V. Russell, the inspector general at the Maryland Department of Health and Mental Hygiene. And they can bring their own cases and collect hefty fines.

Russell said that in addition to federal cases, Maryland's attorney general has taken on 84 cases of alleged fraud in the federal-state Medicaid program for review since the state passed its law last year. None has settled yet.

The task of oversight and enforcement is enormous. Maxim is one of 45,000 Medicaid providers in Maryland.

"We'll never get it all," Russell said. "But the False Claims Act and the other tools are proving really helpful."

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