U.S. Department of Health & Human Services
FOR IMMEDIATE RELEASE
Monday, February 11, 2013
Departments
of Justice and Health and Human Services announce record-breaking
recoveries resulting from joint efforts to combat health care fraud
Government Teams Recovered $4.2 Billion in FY 2012
WASHINGTON
– Attorney General Eric Holder and Health and Human Services (HHS)
Secretary Kathleen Sebelius today released a new report showing that for
every dollar spent on health care-related fraud and abuse
investigations in the last three years, the government recovered $7.90.
This is the highest three-year average return on investment in the
16-year history of the Health Care Fraud and Abuse (HCFAC) Program.
The
government’s health care fraud prevention and enforcement efforts
recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY)
2012, up from nearly $4.1 billion in FY 2011, from individuals and
companies who attempted to defraud federal health programs serving
seniors and taxpayers or who sought payments to which they were not
entitled. Over the last four years, the administration’s enforcement
efforts have recovered $14.9 billion, up from $6.7 billion over the
prior four-year period. Since 1997, the HCFAC Program has returned more
than $23 billion to the Medicare Trust Funds.
These
findings, released today in the annual HCFAC Program report, are a
result of President Obama making the elimination of fraud, waste and
abuse, particularly in health care, a top priority for the
administration.
The
success of this joint Department of Justice and HHS effort was made
possible by the Health Care Fraud Prevention and Enforcement Action Team
(HEAT), created in 2009 to prevent fraud, waste and abuse in the
Medicare and Medicaid programs and to crack down on individuals and
entities that are abusing the system and costing American taxpayers
billions of dollars. These efforts to reduce fraud will continue to
improve with new tools and resources provided by the Affordable Care
Act.
“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,” said Attorney General
Holder. “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 report demonstrates our serious commitment to prosecuting health
care fraud and safeguarding our world-class health care programs from
abuse.”
“Our
historic effort to take on the criminals who steal from Medicare and
Medicaid is paying off: We are gaining the upper hand in our fight
against health care fraud,” said Secretary Sebelius. “This fight against
fraud strengthens the integrity of our health care programs and helps
us fulfill our commitment to our seniors.”
About
$4.2 billion stolen or otherwise improperly obtained from federal
health care programs was recovered and returned to the Medicare Trust
Funds, the Treasury and others in FY 2012. This is an unprecedented
achievement for the HCFAC Program, a joint Justice Department and HHS
effort to coordinate federal, state and local law enforcement activities
to fight health care fraud and abuse.
The
administration is also using tools authorized by the Affordable Care
Act to fight fraud, including enhanced screenings and enrollment
requirements, increased data sharing across the government, expanded
recovery efforts for overpayments and greater oversight of private
insurance abuses.
Since
2009, the Justice Department and HHS have improved their coordination
through HEAT and increased the number of Medicare Fraud Strike Force
teams to nine. The Justice Department’s enforcement of the civil False
Claims Act and the Federal Food, Drug and Cosmetic Act have produced
similar record-breaking results. These combined efforts coordinated
under HEAT have expanded local partnerships and helped educate Medicare
beneficiaries about how to protect themselves against fraud. In FY
2012, the two departments continued their series of regional fraud
prevention summits, and the Justice Department hosted a training
conference for federal prosecutors, FBI agents, HHS Office of Inspector
General agents and others.
The
strike force teams use advanced data analysis techniques to identify
high-billing levels in health care fraud hot spots so that interagency
teams can target emerging or migrating schemes as well as with chronic
fraud by criminals masquerading as health care providers or suppliers.
In July, Attorney General Holder and Secretary Sebelius announced the
launch of a ground-breaking partnership among the federal government,
state officials, leading private health insurance organizations and
other health care anti-fraud groups to share information and best
practices to improve detection of and prevent payments to scams that cut
across public and private payers.
In
FY 2012, the Justice Department opened 1,131 new criminal health care
fraud investigations involving 2,148 potential defendants, and a total
of 826 defendants were convicted of health care fraud-related crimes
during the year. The department also opened 885 new civil
investigations.
The
strike force coordinated a takedown in May 2012 that involved the
highest number of false Medicare billings in the history of the strike
force program. The takedown involved 107 individuals, including doctors
and nurses, in seven cities, who were charged for their alleged
participation in Medicare fraud schemes, involving about $452 million in
false billings. As a part of the May 2012 takedown, HHS also suspended
or took other administrative action against 52 providers using authority
under the health care law to suspend payments until an investigation is
complete.
Strike
force operations in the nine cities where teams are based resulted in
117 indictments, informations and complaints involving charges against
278 defendants who allegedly billed Medicare more than $1.5 billion in
fraudulent schemes. In FY 2012, 251 guilty pleas and 13 jury trials were
litigated, with guilty verdicts against 29 defendants, in strike force
cases. The average prison sentence in these cases was more than 48
months.
The
new authorities under the Affordable Care Act granted to HHS and the
Centers for Medicare & Medicaid Services (CMS) were instrumental in
clamping down on fraudulent activity in health care. In FY 2012, CMS
began the process of screening all 1.5 million Medicare-enrolled
providers through the new Automated Provider 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 Medicare’s billing system.
CMS
also established the Command Center to improve health care-related
fraud detection and investigation, drive innovation and help reduce
fraud and improper payments in Medicare and Medicaid.
From
May 2011 through the end of 2012, more than 400,000 providers were
subject to the new screening requirements and nearly 150,000 lost the
ability to bill the Medicare program due to the Affordable Care Act
requirements and other proactive initiatives.
The
Department of Justice and HHS also continued their successes in civil
health care fraud enforcement during FY 2012. The Justice Department’s
Civil Division Fraud Section, with their colleagues in U.S. Attorneys’
offices throughout the country, obtained settlements and judgments of
more than $3 billion in FY 2012 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 Food and Drug Administration, Medicare fraud by
hospitals and other institutional providers, and violations of laws
against self-referrals and kickbacks. This marked the third year in a
row that more than $2 billion has been recovered in FCA health care
matters. Additionally, the Civil Division’s Consumer Protection Branch,
working with U.S. Attorneys’ offices, obtained nearly $1.5 billion in
fines and forfeitures, and obtained 14 convictions in matters pursued
under the Federal Food, Drug and Cosmetic Act.
The HCFAC annual report is available at www.oig.hhs.gov/publications/ hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.
For more information on the fraud prevention accomplishments under the Affordable Care Act visit: www.healthcare.gov/news/ factsheets/2012/02/medicare- fraud02142012a.html.
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