Feds report $3.3B in healthcare fraud recoveries

The word fraud framed by other words
The federal government's healthcare fraud-fighting efforts recovered more than $3.3 billion in fiscal year 2016. (Getty/Devonyu)

The federal government's healthcare fraud-fighting efforts recovered more than $3.3 billion in fiscal year 2016, up from the $2.4 billion in recoveries the previous year.

Of that total, about $1.7 billion was paid back to the Medicare Trust Funds and $235.2 million in federal Medicaid money transferred back to the U.S. Treasury, according to the Health Care Fraud and Abuse Control (HCFAC) program’s annual report (PDF).

Here are some additional highlights from the program’s annual report:

  • Investigations conducted by the Department of Health and Human Services Office of Inspector General resulted in 765 criminal actions against individuals or entities, and 690 civil actions.
  • HHS OIG excluded 3,635 individuals and entities from participation in Medicare, Medicaid and other federal healthcare programs.
  • The Department of Justice opened 975 new criminal healthcare fraud investigations, with prosecutors filing criminal charges in 480 cases involving 802 defendants. Of those defendants, 658 were convicted of healthcare fraud-related crimes.
  • The DOJ opened 930 new civil healthcare fraud investigations in FY 2016. It had 1,422 civil healthcare fraud matters pending at the end of the fiscal year.
  • Investigations by the FBI resulted in more than 555 “operational disruptions” of criminal fraud organizations and the “dismantlement of the criminal hierarchy” of more than 128 healthcare fraud criminal enterprises.

The report also notes that the HHS secretary and U.S. Attorney General certified $282.1 million in mandatory funding for the HCFAC program—after accounting for mandatory sequester reductions of $20.6 million—as well as $681 million in discretionary funding. By comparison, the program received more than $301 million in mandatory funding and $672 million in discretionary funding in FY 2015.

The HCFAC program’s main source of funding—allocations from Congress—will be unaffected by a repeal of the Affordable Care Act, FierceHealthPayer has reported. Yet President-elect Donald Trump’s administration may choose to scrutinize the program’s discretionary funding, particularly on high-dollar initiatives like the Centers for Medicare & Medicaid Services’ analytics-driven Fraud Prevention System.