February 27, 2014

Another Record-Breaking Year in the Government’s Campaign Against Health Care Fraud

Hand-CuffsBy Jason Enzler

The Departments of Justice and Health and Human Services released their annual Health Care Fraud and Abuse Control Program report yesterday to much fanfare.  And justifiably so.  The report documented the breaking of several records in the government’s ongoing fight against health care fraud.

According to the report, for every $1 the government spent on combating health care fraud over the past three years, it has recovered $8.10. Others would argue that the return investment has been even higher, with some measuring it as high as $20 recovered for every $1 spent.

Other interesting firsts in FY 2013:

  • The government recovered $4.3 billion, up from $4.2 billion in FY 2012
  • FY 2013 marks the fifth consecutive year that the government has increased its health care fraud recoveries (to put things in perspective, in FY 2008, the government recovered $2 billion in health care fraud cases)
  • The government: (1) filed 137 new cases, (2) criminally charged 345 individuals, (3) secured 234 guilty pleas, and (4) obtained 46 jury convictions in health care fraud cases – all new records

These successes are the direct result of the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in 2009, a joint venture between the DOJ and HHS.  Based upon other significant figures in the report, FY 2014 may continue this record-setting trend.  Most notably, the DOJ opened over 2,000 new criminal and/or civil health care fraud investigations last year.  The coming year could see a lot of activity as those investigations progress.

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One Response to “Another Record-Breaking Year in the Government’s Campaign Against Health Care Fraud

  1. DoJ overstates the efforts of its task forces. When I was with DCIS, I noticed the Financial Crimes Task Force was often publicly credited for the success of an investigation, when the “task force” had no official involvement. It seemed that simply because DCIS, as an agency, was a member of the task force, the task force took credit for the investigation. Similarly, the Miami HEAT was credited with a settlement in a case in Pensacola, FL, over 10 hours away. The only connection to the Miami HEAT was that the HHS agent was assigned to HHS’ Miami Field Office (though physically located elsewhere).