Profitably Reining in Health Care Fraud

The U.S. Department of Justice (DOJ) and the HHS say joint efforts to combat health care fraud have seen more than $27.8 billion returned to the Medicare Trust Fund. During fiscal year 2014 alone, the Health Care Fraud and Abuse Control (HCFAC) Program recovered $3.3 billion in taxpayer dollars from individuals and companies that attempted to defraud federal health programs, including programs serving seniors, people with disabilities, and those with low incomes.

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For every dollar spent on health care-related fraud and abuse investigations in the past 3 years, the administration has recovered $7.70—$2 higher than the average return on investment since the HCFAC Program was created in 1997.

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The success in recovering money is due to a 2-pronged strategy. First, instead of “pay and chase” efforts targeting fraudsters, the administration implements programs that aim to prevent fraud and abuse in the first place, according to an HHS press release. Second, the Health Care Fraud Prevention and Enforcement Action Team—run jointly by HHS and DOJ—is changing how the government fights certain types of health care fraud. Now, cases are investigated through real-time data analysis, not a prolonged subpoena and account analysis, according to HHS. This means a significantly shorter time between identification of fraud, arrest, and prosecution.