Health and Human Services and the Department of Justice say that a record-breaking $4.2 billion were recovered as a result of joint efforts to address health care fraud in 2012.
Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder issued a report which showed that for every dollar the US government spent on health care-related fraud and abuse investigations over the last 36 months, it got $7.90 back. This is a record over a three-year period since the HCFAC (Health Care Fraud and Abuse) Program began sixteen years ago.
Is this huge haul a sign of better coordination among public authorities, or does it reflect an increase in criminality? The Justice Department and HHS believe it is a sign of the government’s health care fraud prevention and enforcement efforts. $4.2 billion (2012) is an increase from $4.1 billion in 2011.
The money was recovered from companies and individuals who had tried to defraud federal health programs aimed at seniors and taxpayers for payments they were not entitled to receive. $14.9 billion have been recovered over the last four years, compared to $6.7 billion during the previous four-year period. Over $23 billion have been returned to the Medicare Trust Funds since 1997 by the HCFAC Program.
HEAT (Health Care Fraud Prevention and Enforcement Action Team) was created in 2009 to fight fraud, abuse and waste in the Medicaid and Medicare programs, and to close in on people and entities which abuse the system and cost the American taxpayers billions of dollars. A takedown involving the highest number of false Medicare billings in history of the strike force program occurred in 2012. It involved 107 people, including nurses and doctors in seven cities. They were charged for taking part in Medicare fraud schemes totaling approximately $452 billion in fraudulent billings. During that takedown, HHS also suspended or took other action against 52 providers to suspend payments until the investigation was completed.
Last year, 251 guilty pleas and 13 jury trials were brought to court. Twenty-nine defendants had guilty verdicts against them in strike force cases. Those found guilty were given prison sentences averaging over 48 months.