The Department of Health and Human Services and the Department of Justice Health Care Fraud and Abuse Control Program published their Annual Report for Fiscal Year 2017.

The Federal Government won or negotiated over $2.4 billion in health care fraud judgments and settlements in 2017, and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, $2.6 billion was returned to the Federal Government or paid to private persons.

Of this $2.6 billion, the Medicare Trust Funds received transfers of approximately $1.4 billion during this period, and $406.7 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts.

In FY 2017, the Department of Justice opened 967 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 439 cases involving 720 defendants A total of 639 defendants were convicted of health care fraud-related crimes during the year.

Also in FY 2017, DOJ opened 948 new civil health care fraud investigations and had 1,086 civil health care fraud matters pending at the end of the fiscal year. In FY 2017, the FBI investigative efforts resulted in over 674 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 148 health care fraud criminal enterprises.

In FY 2017, investigations conducted by HHS’ Office of Inspector General (HHS-OIG) resulted in 788 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 818 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.

HHS-OIG also excluded 3,244 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs. Among these were exclusions based on criminal convictions for crimes related to Medicare and Medicaid (1,281) or to other health care programs (309), for patient abuse or neglect (266), and as a result of licensure revocations (973).

HHS-OIG also issued numerous audits and evaluations with recommendations that, when implemented, would correct program vulnerabilities and save program funds.

Due to sequestration of mandatory funding in 2017, there were fewer resources for DOJ, FBI, HHS, and HHS-OIG to fight fraud and abuses against Medicare, Medicaid, and other health care programs. A total of $20.7 million was sequestered from the HCFAC program in FY 2017, for a combined total of $115.5 million in the past five years. Including funds sequestered from the FBI and the FY 2013 discretionary HCFAC sequester, the total equals $161.7 million in the past five years.