The U.S. Justice Department announced on March 19 that the federal government has recovered $3.3 billion from suspected companies and individuals attempting health care fraud schemes for the fiscal year of 2014.
Although the recovered amount is $1 billion less than what was claimed in previous years, Justice Department spokesman Kevin Lewis explains that in 2012 and 2013, there were recoveries from criminal investigations and settlements against known pharmaceutical companies. Other substantially large fraud cases were also made. Thus, 2012 saw the recovery of $4.2 billion. Another $4.3 billion was reclaimed in 2013.
"The extraordinary return on investment we've obtained speaks to the skill, the tenacity, and the inspiring success of the hardworking men and women fighting on behalf of the American people and with these outstanding results, we are sending the unmistakable message that we will not waver in our mission to pursue fraud, to protect vulnerable communities, and to preserve the public trust," said Eric Holder, Attorney General.
The $7.70 recovered for every dollar spent on health care-related fraud and abuse investigations can be accredited to the joint efforts of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in coordination with Health and Human Services (HHS), Office of Inspector General, and Justice Department. The agencies have all been working closely for the past three years to make real changes through simultaneous data analysis, which led to the reduced length of time between the identification of fraud attempts and the arrest and actual prosecution of offenders.
"These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of health care fraud and prevent future fraud and abuse," said HHS Secretary Sylvia Burwell as she explained the success of their efforts.
"New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door. And together with the continued support of Congress and our partners at the Department of Justice, we've cracked down on tens of thousands of health care providers suspected of Medicare fraud - all of which are helping to extend the life of the Medicare Trust Fund," added Burwell.
The Centers for Medicare & Medicaid Services (CMS) have also been working to prevent fraudulent occurrence. The CMS must revalidate all existing Medicare providers and suppliers under new screening requirements required by the Affordable Care Act. This practice led them to identify and deactivate 450,000 questionable enrollments and withdraw 27,000 other dubious enrollments, preventing certain providers from re-enrolling and billing Medicare and Medicaid.
A Medicare Fraud Strike Force has also been formed and currently operates out of nine locations: Brooklyn, Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, Southern Louisiana and Tampa. An impressive number of 734 offenders were convicted of health care fraud-related offenses in 2014, while 924 new criminal health care fraud investigations were opened due to the tireless efforts of the Medicare Fraud Strike Force and Justice Department in conjunction with other offices determined to stop fraudulent activities.
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