OIG report: Feds clawed back $3.6B in fraud recoveries in 2019

shows the backs of two female enforcement officers with Police HHS/OIG insignia
OIG released its annual look at fraud recoveries this week. (Department of Health and Human Services Office of Inspector General)

The feds recovered nearly $3.6 billion in healthcare fraud dollars in 2019, new data released by the Trump administration show.

The Department of Health and Human Services Office of Inspector General (OIG) released its annual look back at fraud recoveries, which showed that of the $3.6 billion clawed back, over $2.5 billion was deposited into Medicare trust funds.

OIG said that the federal government won or negotiated more than $2.6 billion in judgements or settlements in fraud causes during 2019. The remaining funds were brought in through settlements or judgements from prior years, according to the report.

Featured Webinar

Reducing barriers to patient care: A cross-industry collaboration

Optum will bring together cross-industry experts to share a case study detailing how an employer, provider, payer and pharmaceutical company worked together to address migraines, a hard-to-diagnose condition. Learn how this team started with a model to risk stratify, predict undiagnosed, misdiagnosed and mismanaged members and how those analytics were used to enrich engagement for treatment and diagnosis optimization.

In fiscal year 2019, the Department of Justice (DOJ) opened 1,060 new criminal healthcare fraud investigations, with federal prosecutors filing charges against 814 defendants across 485 cases.

RELATED: OIG finds $1.51B in savings from fraud, details efforts to combat COVID-19 scammers

DOJ opened 1,112 new civil healthcare fraud investigations in 2019 as well, according to the report.

In addition, investigations conducted by the Federal Bureau of Investigation led to the operational disruption of 558 criminal fraud organizations and dismantled the hierarchy of 151 healthcare fraud schemes, OIG said.

Fraud investigations conducted by OIG itself led to 747 criminal actions against individuals or entities engaged in schemes to defraud Medicare and Medicaid, and 684 civil actions. HHS also excluded 2,640 individuals from participating in federal healthcare programs in 2019, with 1,194 cases linked to crimes against Medicare and Medicaid, according to the report.

Suggested Articles

A New Jersey medical office has filed suit against Cigna, alleging that the insurer failed to pay for diagnostic testing and treatment for COVID-19.

CMS issued new guidance Friday to help states implement the new interoperability policies in Medicaid and CHIP programs.

GoodRx has released its latest list of the most expensive drugs in America, with orphan drugs and therapies for rare conditions topping the ranking.