HHS recovered $2.6B from healthcare fraud in 2017, down 21% from the previous year

In 2017 HHS and the DOJ netted over $2 billion from healthcare fraud cases, down from 2016 recoveries. (pasja1000)

A healthcare fraud-fighting program overseen by the Department of Justice and the Department of Health and Human Services raked in $2.6 billion from judgments and settlements last year, a significant decline from the previous year. 

Of that total, $1.4 billion was paid back to the Medicare Trust Funds and $406.7 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).

“Today’s report highlights the success of HHS and DOJ’s joint fraud-fighting efforts,” Health and Human Services Secretary Alex Azar said in a statement. “By holding individuals and entities accountable for defrauding our federal health programs, we are protecting the programs’ beneficiaries, safeguarding billions in taxpayer dollars and, in the case of pill mills, helping stem the tide of our nation’s opioid epidemic.”


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Despite Azar's praise of the report, the recovered amount is down nearly 21% from last year, when the HCFAC clawed back $3.3 billion following the integration of sophisticated data analytics. It's the first such report under the Trump administration and a tumultuous first year for HHS in which its first confirmed secretary, Tom Price, was ousted in September

RELATED: DOJ's limits on use of guidance documents in federal action could hinder fraud prosecution

However, the number of criminal actions against individuals or entities was up from 765 in 2016 to 788 in 2017, according to the report. Civil actions also jumped from 690 to 818. 

Additionally, for every dollar the government spent on healthcare-related fraud investigations in the past three years, four dollars were recovered, according to the report. In 2016, the program boasted a 5-1 ratio.

The Trump administration recently made changes to how fraud in the healthcare sector is approached and handled. In February the DOJ established new limits on how federal prosecutors pursue violations of guidance documents in civil cases against companies, which could cause prosecutors difficulties.

But fraud and waste remain a key area of focus for the administration. Last year, the DOJ created an Opioid Fraud and Abuse Detection Unit backed by data analytics. Trump has also called for more discretionary funding for the HCFAC. 

In January, the Department of Veteran Affairs and HHS announced a data analytics partnership to help the VA combat healthcare fraud.

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