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Health Care Fraud and Prevention Recovers $4 Billion


More than $4 billion in taxpayer money was recovered from health care fraud in 2011 and close to 1,500 defendants were charged.

More than $4 billion in taxpayer money was recovered from health care fraud in 2011, according to a report by the Department of Health and Human Services. The money was recovered through the joint effort of the HHS and the Department of Justice.

According to HHS Secretary Kathleen Sebelius, going after fraud has proven to be one of the best investments. For every $1 spent, HHS and DOJ were able to put $7 back into the hands of taxpayers, she said at a press conference Tuesday. The $4.1 billion recovered in 2011 was an increase of 58% over 2009.

Federal prosecutors filed charges against more than 1,400 defendants with 743 convicted.

Of those caught were

323 defendants

who collectively billed more than $1 billion to the Medicare program. They

were picked up by

Medicare Strike Force teams. In 2011 there had been an increased number of teams on the ground in hot spots.

Over the years, medical scams were not only getting bigger but the criminals were getting more creative.

“They were evolving and we needed to catch up,” Sebelius said.

Instead of taking the typical route of chasing criminals who have already committed fraud, the government has worked on making it more difficult to commit fraud in the first place. According to Sebelius, the report only captures part of the impact being made.

Additional measures have been put into place that can recognize suspicious claims as they are made, similar to how a credit card company can flag suspicious charges.

Both HHS and DOJ have additional money in their budgets so they can expand their efforts to additional cities in 2012. The cities being looked at to place strike force teams could not be named.

“Despite these remarkable successes we know that we cannot rest, but we have to expand our efforts to the next level,” said Attorney General Eric Holder.

The efforts of the DOJ and HHS were possible through tools and resources provided by the Affordable Care Act. In addition to the $350 million in funding that had been made available for the Health Care Fraud and Abuse Control Program, the administration had used tools like enhanced screenings and enrollment requirements, and greater oversight of private insurance abuses.

“There is more work to be done, but today’s report shows that we are moving in the right direction,” Sebelius said. “It sends a clear message … to criminals [that] the days when stealing from Medicare and Medicaid, when that was easy money, those days are over.”

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