Health Fraud Probes by U.S. Recouped $4.3 Billion in 2013

U.S. Health-Care
The Justice Department in the 2013 fiscal year opened 1,013 new criminal investigations of alleged health-care fraud involving almost 2,000 suspects, according to the report. Photographer: Patrick T. Fallon/Bloomberg

The federal government recovered a record $4.3 billion during the past fiscal year from people and companies that attempted to defraud health-care programs, according to two U.S. agencies.

The total for fiscal 2013, which ended Sept. 30, topped by $100 million what the U.S. reported as recovered in the previous year and was more than double the haul in fiscal 2008, the departments of Justice and Health and Human Services said today in a joint statement.

For every dollar spent on health-care fraud inquiries, the government recovered $8.10, the agencies said. Recoveries in the 2013 fiscal year came in the form of criminal, civil and administrative judgments and settlements.

“With these extraordinary recoveries, and their record-high rate of return on investment we’ve achieved on our comprehensive health-care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens,” Attorney General Eric Holder said in a statement.

The agencies said that new powers granted under the 2010 Affordable Care act “were instrumental” in the crackdown on health-care fraud.

The figures were contained in the annual Health Care Fraud and Abuse Control Program report, released this morning.

The Justice Department in the 2013 fiscal year opened 1,013 new criminal investigations of alleged health-care fraud involving almost 2,000 suspects, according to the report. More than 700 people were convicted of health-care fraud crimes during that period, the report said.

Agency Coordination

The departments also credited better coordination among government agencies and data analysis programs that help pinpoint health-care fraud hotspots for the increase in recovered funds.

The Centers for Medicare and Medicaid Services in 2011 began revalidating 1.5 million Medicare-enrolled providers as part of the 2010 health-care law, the report said. Since then, CMS has revoked 14,663 providers’ and suppliers’ authority to bill Medicare because of felony convictions, not being operational at the address on file or failing to comply with rules.

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