Federal officials’ healthcare fraud efforts recovered a record $4.3 billion in fiscal year 2013, up from $4.2 billion in 2012. Since 1997, the program has recovered nearly $26 billion to the Medicare trust funds.
Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius released the annual Health Care Fraud and Abuse Control Program report, showing that for every dollar spent on healthcare-related fraud and abuse investigations in the last three years, the government recovered $8.10, the highest three-year average return on investment in the 17-year history of the HCFAC program. “With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive healthcare fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal healthcare programs,” Holder said. “Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective. And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends.”
The Justice Department and HHS have improved their coordination through HEAT and are currently operating Medicare Fraud Strike Force teams in nine areas across the country. The strike force teams use advanced data analysis techniques to identify high-billing levels in healthcare fraud hot spots, so that interagency teams can target emerging or migrating schemes as well as chronic fraud by criminals posing as health professionals.
In FY 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234), and jury trial convictions (46). Beyond that, the defendants who were charged and sentenced are facing significant time in prison – an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007, officials said. Justice Department officials opened 1,013 new criminal healthcare fraud investigations involving 1,910 potential defendants in FY 2013, and a total of 718 defendants were convicted of healthcare fraud-related crimes during the year. The department also opened 1,083 new civil healthcare fraud investigations.
“These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” said HHS Secretary Sebelius. “We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. 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.”