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Government Nets Record $4.2 Billion in Recovered Healthcare Fraud Cases
The government had another record-breaking year in health care fraud enforcement efforts, recovering $4.2 billion for fiscal year 2012. The combined venture by the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) has returned more than $23 billion dollars to Medicare since the inception of the Health Care Fraud and Abuse Program (HCFAC) in 1997.
The government says HCFAC has recovered nearly $8 for every dollar spent in pursing health care fraud over the past three years, which is the “highest three-year average return on investment” in the history of the HCFAC. Officials attribute the success of HCFAC to the Health Care Fraud Prevention and Enforcement Action Team, which was created in 2009 and is tasked with preventing fraud, waste and abuse in the Medicare and Medicaid programs.
In FY 2012, the DOJ opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, and opened 885 new civil investigations. HHS credits the recovery of the “stolen or otherwise improperly obtained” funds in large part to actions taken under the False Claims Act and to advanced fraud detection software that has been recently developed and implemented.
Civil investigations yielded approximately $3 billion of the recovered funds, and related primarily to unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and off-label uses of pharmaceutical products, violations of laws against self-referrals and kickbacks, and violations of other Medicare requirements.