Are federal fraud programs effective?

The U.S. Department of Health & Human Services has allocated hundreds of millions of dollars to rooting out and preventing fraud in Medicare and Medicaid, but a new report shows HHS fraud prevention programs might not be effective.

In 2012, HHS directed $583.6 million to healthcare fraud and abuse control (HCFAC) activities, including Medicare strike force teams that provide extra investigative and prosecutorial resources in nine cities with high rates of healthcare fraud, according to a report from the Government Accountability Office.

Despite these funds, HHS, its Office of Inspector General and the U.S. Department of Justice have been unable to determine whether they have actually boosted anti-fraud efforts, primarily because of a lack of information.

"Several factors contribute to a lack of information about the effectiveness of HCFAC activities in reducing healthcare fraud and abuse," the report says. "The indicators agencies use to track HCFAC activities provide information on the outputs or accomplishments of HCFAC activities, not on the effectiveness of the activities in actually reducing fraud and abuse."

The tracking measures HHS and DOJ use to follow HCFAC activities provide information on accomplishments of HCFAC activities rather than on whether the activities effectively reduced fraud and abuse.

The GAO recognizes preventing and reducing fraud as "an essential yet challenging task" and says better information could inform agency decisions about how to best allocate resources for stopping healthcare fraud. That can result in higher return on investments, as a report from the Taxpayers Against Fraud Education Fund found healthcare fraud prevention can provide $20 for every $1 invested in fraud cases, FierceHealthcare previously reported.

To learn more:
- here's the GAO report (.pdf)

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