DOJ-HHS anti-fraud effort recovered $3.3 billion in 2014

More than $27.8 billion has been returned to the Medicare Trust Fund since the inception of the Health Care Fraud and Abuse Control (HCFAC) Program in 1997, according to a new report from the Departments of Justice (DOJ) and Health and Human Services (HHS).

The program recovered $3.3 billion of taxpayer money in the 2014 fiscal year alone. Approximately $1.9 billion was transferred to the Medicare Trust Funds and another $523 million to the Treasury.

Healthcare organizations faced a higher level of fraud scrutiny in 2014 than ever before, as FierceHealthPayer: AntiFraud previously reported.

HCFAC recovered $7.70 for every dollar spent on healthcare-related fraud and abuse for fiscal 2014. This is around $2 more than the average return on investment in the program's 18 years and is its third-highest ROI ever.

"Eliminating fraud, waste and abuse is a top priority for the Department of Health and Human Services," HHS Secretary Sylvia Mathews Burwell said in a statement. Secretary Burwell serves as director of HCFAC along with Attorney General Eric Holder.

"These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of healthcare fraud and prevent future fraud and abuse," Burwell said. "New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door."

The program pursued criminal and civil investigations of medical device companies, pharmaceutical companies, hospitals, physicians, pharmacies, chiropractors, hospice facilities and others, according to the report.

New authorities granted by the Affordable Care Act allow HCFAC to implement programs that move away from the "pay and chase" efforts of the past. Cases are investigated through real-time data analysis instead of protracted subpoena and account analyses, resulting in a shorter time between fraud identification and prosecution.

The DOJ opened 924 new criminal healthcare fraud investigations in fiscal 2014, according to the report. Federal prosecutors filed criminal charges against 805 defendants in 496 cases, with 734 defendants convicted of fraud-related crimes during the year. The DOJ also opened 782 new civil healthcare fraud investigations.

In addition to the DOJ activities, the FBI disrupted 605 criminal fraud organizations and dismanted more than 140 healthcare fraud criminal enterprises. Also in fiscal 2014, the HHS Office of Inspector General brought criminal actions against 867 individuals and entities for crimes related to Medicare and Medicaid, and 529 civil actions for activities such as false claims and unjust-enrichment lawsuits.

The Inspector General also excluded 4,017 individuals and entities from participating in Medicare, Medicaid or other federal health programs based on criminal convictions, patient abuse or neglect and for license revocations.

To learn more:
- read the HCFAC report (pdf)
- check out the HHS statement

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