Health and Science

Give it back! $3.3 billion recouped from health scammers

The federal government in 2014 once again got some significant bang for its buck while combating the persistent—and expensive—problem of health-care fraud.

Federal authorities last year recovered $3.3 billion from companies and individuals that tried to defraud government-run health programs such as Medicare and Medicaid, which primarily cover the elderly and the poor, according to a report issued Thursday.

While that dollar amount is eye-opening, it's just a fraction of the tens of billions of dollars that the FBI has said is lost each year to health-care fraud in the U.S.

Attorney General Eric Holder.
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Still, government officials noted Thursday that "for every dollar spent on health-care-related fraud and abuse investigations in the past three years, the administration recovered $7.70."

That is about $2 higher than the average return on investment over the life of the Health Care Fraud and Abuse Control Program, a joint effort of the U.S. Health and Human Services Department and the Justice Department that was launched in 1997.

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And it's the third-highest rate of return on investment in that program's history.

The HCFAC program in total has recovered more than $27.8 billion for the government's Medicare trust fund since the effort began, authorities noted.

"More taxpayer money is being recovered, more criminals are facing justice, and more fraud is being punished, prevented and deterred," said Attorney General Eric Holder.

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HHS Secretary Sylvia Burwell said that "eliminating fraud, waste and abuse is a top priority for" her department.

Officials highlighted a number of initiatives that have helped both prevent health-care fraud and recoup federal money. Those steps included increased funding to expand the Medicare Fraud Strike Force to nine geographic territories.

Authorities said efforts by the strike force and other initiatives led the Justice Department to open 924 new criminal health-care fraud probes in fiscal 2014. Federal prosecutors actually filed criminal charges in nearly 500 cases, involving more than 800 defendants, and 734 defendants were convicted of health-care-related fraud that year.

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Officials also noted how the Affordable Care Act requires the Centers for Medicare and Medicaid Services to use new screening requirements to revalidate all 1.5 million Medicare suppliers and providers.

"As a result of this and other proactive initiatives, CMS has deactivated 470,000 enrollments and revoked nearly 28,000 enrollments to prevent certain providers from re-enrolling and billing the Medicare program," officials said. "Both of these actions immediately stop billing."

CMS also continued a temporary moratorium on the enrollment of new home health and ambulance service providers in six metropolitan areas considered "hot spots" for health fraud: Miami, Chicago, Dallas, Houston, Detroit and Philadelphia.