Feds recoup $4.3B from fraudsters
HHS, Justice action teams recover $8 for every dollar put into investigations
The Obama Administration recovered a record $4.3 billion last year from fraudsters trying to dupe federal health programs, or those who sought payments to which they were not entitled, according to a report released this week. The report also showed that the feds recouped $8.10 for every dollar spent on investigations over the last three years, its highest average return.
In 2012, the Health Care Fraud and Abuse Control Program recovered $4.2 billion, and over the last five years it has returned $19.2 billion, up $9.4 billion from the last five-year period, to the Medicare Trust Funds and Treasury.
While the program has been in existence for 17 years, the Health and Human Services and Justice Departments have coordinated the Health Care Fraud Prevention and Enforcement Action Team (HEAT) since 2009 specifically to crack down on fraud, waste and abuse in Medicare and Medicaid and those who are gaming and abusing the system.
[See also: Fraud prevention through prediction.]
For example, HEAT coordinated a takedown in May 2013 that resulted in charges by eight cities against 89 individuals, including physicians and nurses, for their alleged participation in Medicare fraud schemes involving $223 million in false billings.
Justice last year opened 1,013 new criminal healthcare fraud investigations involving 1,910 potential defendants, and a total of 718 were convicted of healthcare fraud-related crimes. The department also opened 1,083 new civil healthcare fraud investigations.
Authority provided through the Affordable Care Act has upped the pressure. Last year, the Centers for Medicare & Medicaid Services stopped enrollment of new home health or ambulance services in three fraud hot spots around the country, said HHS Secretary Kathleen Sebelius.
“New enrollment screening techniques are proving effective in preventing high-risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results—all of which are adding to savings for the Medicare Trust Fund,” she said in a news release.
