Federal healthcare fraud efforts saved $4B in 2010

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More than $4 billion in 2010 was recovered and returned to the Medicare Health Insurance Trust Fund through the Obama Administration’s healthcare fraud prevention and enforcement efforts, according to a report from the U.S. Department of Health and Human Services (HHS).

The results are due largely to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which was created in 2009 to prevent waste, fraud and abuse in the Medicare and Medicaid programs, the report stated.

In addition, the Patient Protection & Affordable Care Act (PPACA) provides tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for Healthcare Fraud and Abuse Control Program (HCFAC) activities, HHS stated.

The administration is already using tools authorized by the PPACA, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.

During fiscal year (FY) 2010, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud, HHS stated. The total number of cities with Strike Force prosecution teams was increased to seven.

The Strike Force teams use data analysis techniques to identify high-billing levels in healthcare fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as healthcare providers or suppliers. Strike Force enforcement accomplishments in all seven cities during FY 2010 include:

  • 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million;
  • 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants; and
  • Imprisonment for 146 defendants sentenced during the fiscal year, averaging more than 40 months of incarceration.
Including Strike Force matters, federal prosecutors opened 1,116 criminal healthcare fraud investigations as of the end of FY 2010 and filed criminal charges in 488 cases involving 931 defendants.  A total of 726 defendants were convicted for healthcare fraud-related crimes during the year.

In addition to these criminal enforcement successes, 2010 was a record year for recoveries obtained in civil healthcare matters brought under the False Claims Act—more than $2.5 billion.

The report can be found here.