DoJ, HHS boasts record year in $4.1B healthcare fraud recovery

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The government's crackdown on healthcare fraud is paying off, literally, as the U.S. Department of Health & Human Services and the Justice Department yesterday touted its record-breaking year in recovery. Fraud prevention and enforcement efforts led to nearly $4.1 billion in recovered judgments in fiscal year 2011, according to an annual report.

"Fighting fraud is one of our top priorities, and we have recovered an unprecedented number of taxpayer dollars," HHS Secretary Kathleen Sebelius said in a statement yesterday. "Our efforts strengthen the integrity of our health care programs and meet the President's call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules."

Called an "unprecedented achievement," 2011 was the agencies' most successful year in recovery. The money that would have otherwise been swindled was instead returned to Medicare Trust Funds, the Treasury and other departments, according to HHS.

The government's hard-on-fraud campaign to identify and prevent abuse and waste has been far from a secret in the administration's tone (and actions). Since 2009, DoJ and HHS increased the number of Medicare Fraud Strike Force teams to nine and they coordinated with Health Care Fraud Prevention & Enforcement Action Team, otherwise known as HEAT.

Attorney General Eric Holder echoed the agency's hard-lined approach. "This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs," he said.  

Strike force operations last year charged a record number of 323 defendants, who allegedly collectively billed Medicare more than $1 billion. They secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison, with the average sentence racking up to more than 47 months. 

The departments recovered $2.4 billion in civil healthcare fraud cases under the False Claims Act, including hospitals and other providers committing Medicare fraud, self-referrals and kickbacks.

In line with fraud prevention, the Centers for Medicare & Medicaid Services will conduct Recovery Audit Prepayment reviews, starting on June 1. Rather than pay and chase, recovery audit contractors (RAC) will review historically improper claims before payment so that providers comply with Medicare rules.

For more information:
- read the HHS statement
- check out the HHS report (.pdf)
- read the AP article
- read the Main Justice article

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