U.S. Attorney General Eric Holder (left) and Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, discuss efforts to combat health care fraud at an Oct. 4, 2012, conference in Washington, D.C. (Photo courtesy of the DOJ)
In 2012, a record-breaking $4.2 billion of taxpayer money was recovered from individuals and companies attempting to defraud the federal government through health care programs, according to officials with the U.S. Department of Justice.
On Monday, U.S. Attorney General Eric Holder and Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, released a report showing that for every dollar spent on fraud and abuse investigations in the last three years, the government recovered nearly $8.
“This was a record-breaking year for the departments of Justice and Health and Human Services in our collaborative effort to crack down on health care fraud and protect valuable taxpayer dollars,” Holder said in a press release. “In the past fiscal year, our relentless pursuit of health care fraud resulted in the disruption of an array of sophisticated fraud schemes and the recovery of more taxpayer dollars than ever before."
This is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Program, he added.
"This report demonstrates our serious commitment to prosecuting health care fraud," he said, "and safeguarding our world-class health care programs from abuse.”
Based on the report, the federal government recovered roughly a $100 million more during the 2012 fiscal year than in 2011.
Over the last four years, $14.9 billion has been recovered through stepped up anti-fraud efforts by the departments. Since 1997, the program has returned more than $23 billion to the Medicare trust funds.
Holder and Sebelius credited the Health Care Fraud Prevention and Enforcement Action Team, created in 2009 to prevent fraud, as a primary factor in the successful joint effort.
According to both departments, these efforts to reduce fraud will continue to improve with new tools and resources provided by the Patient Protection and Affordable Care Act, dubbed "Obamacare."
“Our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off," Sebelius said, adding both departments are using new tools that were authorized under Obamacare to prevent criminals from stealing taxpayer dollars.
As part of those efforts, she said, officials are fighting fraud through enhanced screenings and enrollment requirements, increased data sharing between federal agencies, expanded recovery efforts for overpayments, and even more oversight of private insurance companies.
Since 2009, the departments have also increased the number of Medicare Fraud Strike Force teams to nine.
Last year, the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, which resulted in 830 defendants being convicted of health-related crimes. The department also opened 885 new civil investigations.
In addition, the Health and Human Services Department partnered with the Centers for Medicare and Medicaid Services to clamp down on fraudulent activity.
Subsequently, officials used new powers granted to them under Obamacare to screen all 1.5 million Medicare-enrolled providers through a new automated screening system that quickly identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation to verify the data.
As a result, nearly 150,000 ineligible providers have already been eliminated from the Medicare billing system.
From May 2011 through the December 2012, more than 400,000 providers were subject to revised screening requirements and nearly 150,000 lost the ability to bill the Medicare program due to new mandates, and other proactive initiatives.
These new powers, Sebelius said, are ensuring that both departments can effectively combat health care fraud, noting the billions of dollars that have been recovered will benefit Medicare recipients in the long run.
"We are gaining the upper hand in our fight against health care fraud," Sebelius said in a press release. "This fight against fraud strengthens the integrity of our health care programs and helps us fulfill our commitment to our seniors.”