Nearly $4.1 billion recovered in health fraud
The government's health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in 2011, the highest annual amount ever recovered.
Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently released the annual Health Care Fraud and Abuse Control Program (HCFAC) report, which noted that the total number of cities with "strike force" prosecution teams was increased to nine. All nine teams have investigators and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General dedicated to fighting fraud.
The strike force teams use advanced data analysis techniques to identify high-billing levels in healthcare fraud hotspots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as healthcare providers or suppliers. In 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion.
Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial, and sentenced 175 defendants to prison. The average prison sentence in strike force cases in 2011 was more than 47 months.
Including strike force matters, federal prosecutors filed criminal charges against 1,430 defendants for healthcare fraud-related crimes. This amount is the highest number of healthcare fraud defendants charged in a single year in the department's history. Including strike force matters, 743 defendants were convicted for healthcare fraud-related crimes during the year.
In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution. and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity, or quality required by the FDA.
The departments also continued their successes in civil healthcare fraud enforcement during FY 2011. About $2.4 billion was recovered through civil healthcare fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. FY 2011 marked the second year in a row that more than $2 billion has been recovered in FCA healthcare matters. Since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal healthcare dollars.
The fraud prevention and enforcement report coincided with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers' money.
The HCFAC annual report can be found at oig.hhs.gov/publications/hcfac.asp. For more information on the joint Department of Justice (DOJ)-HHS Strike Force activities, visit www.StopMedicareFraud.gov.
The government's health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in 2011, the highest annual amount ever recovered.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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