The federal government recouped $3 billion in health fraud settlements and judgments in fiscal 2014, down from $4 billion in 2013, according to a March 19 announcement by the Department of Health and Human Services.
The Health Care Fraud and Abuse Control (HCFAC) Program has recovered nearly $30 billion since it began in 1997.
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The Department of Justice (DOJ) in 2014 also opened 924 new criminal health care fraud investigations, and federal prosecutors filed criminal charges in 496 cases involving 805 defendants, HHS said in its report. A total of 734 defendants were convicted of health care fraud–related crimes during last year.
Meanwhile, investigations by the HHS Office of Inspector General resulted in 867 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid and 529 civil actions, which include false claims and unjust-enrichment lawsuits. HHS excluded 4,017 health providers from participation in Medicare and Medicaid and other federal health care programs as a result of program violations, criminal actions, and licensure revocations.
The government touted the False Claims Act (FCA) as a leading tool in the fight against health fraud and recoupment of funding.
In 2014, the DOJ civil division, along with state officials, obtained $2.3 billion in settlements and judgments from FCA cases involving fraud and false claims. The department also opened 782 new civil health care fraud investigations under the FCA and had 957 civil health care fraud matters pending at the end of 2014.
For every dollar spent on health care–related fraud and abuse investigations in the last 3 years, HHS officials said they recovered $7.70. This is about $2 higher than the average return on investment when HCFAC was created in 1997.
However, the report noted that there were fewer resources for the federal government to fight health fraud and abuses because of sequestration of mandatory funding in 2014. A total of $32 million was sequestered from the HCFAC program in fiscal 2014, for a combined total of $62 million in the past 2 years.
agallegos@frontlinemedcom.com
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