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Federal fraud recoveries skyrocketed

Yet crime persists, with $80B overpaid annually

Federal health insurance anti-fraud efforts recouped about $4.3 billion in fiscal year 2013, the U.S. Departments of Justice and Health and Human Services announced Wednesday, recovering $8.10 for every taxpayer dollar spent on this work during the last three years. And government teams took back $19.2 billion in inappropriate payments over the last five years.

The Healthcare Fraud and Abuse Control Program (HCFAC) returned more than $25.9 billion to the Medicare trust funds and treasury since the program's 1997 launch, according to an HHS report. These recoveries stemmed partly from efforts of nine nationwide Health Care Fraud Prevention and Enforcement Teams (HEAT) created to nab Medicare and Medicaid abusers.

"Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective," U.S. Attorney General Eric Holder said in the announcement. "And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends."

For example, the Medicare Strike Force filed 137 cases, charged 345 people, and obtained 234 guilty pleas and 46 jury trial convictions in fiscal year 2103, as FierceHealthPayer reported.

New powers given to HHS and the Centers for Medicare & Medicaid Services under the Affordable Care Act have been instrumental in combating fraud. CMS, for instance, applied temporary moratoria to new home healthcare and ground ambulance provider applications in fraud zones.

Nevertheless, the FBI says healthcare fraud costs the country at least $80 billion annually, The Hill Healthwatch noted.

And though the culprits change, many health insurance fraud cases follow a recurrent pattern, Crain's Detroit Business reported: A ringleader hatches a plan to claim payment for unnecessary or bogus healthcare services in an area where monitoring is considered lax. Runners convince people who need cash or a free meal to divulge their health insurance identification numbers. And as false claims start arriving, healthcare providers may join in the crime, Crain's noted.

For more:
- read the HHS announcement
- here's the HCFAC Program report (.pdf)
- check out the Healthwatch article
- see the Crain's article

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