The Burrill Report

Federal authorities say that they recovered $4.1 billion in fraudulent healthcare payments during 2011, the largest amount ever collected in a single year, from judgments and settlements in Medicare and Medicaid fraud cases, according to the U.S. Department of Justice and the U.S. Department of Health and Human Services.

Authorities have long said that the solution to solving the fraud problem, estimated to cost $60 billion to $90 billion per year, lies in more aggressively screening providers. The Centers for Medicare and Medicaid Services has been under attack in recent years for lax screening practices.

Much of the success in 2011, according to HHS, was due to more stringent practices enacted by the Health Care Fraud Prevention & Enforcement and the Medicare Strike Force teams, both created for the purpose of eliminating fraudulent claims.

The task forces used data analysis to identify high billing levels in healthcare hot spots, such as Detroit and Miami, and target claims for investigation and possible prosecution. The more thorough analysis amounted to a record 1,430 criminal fraud charges in 2011, which led to 743 convictions.

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said HHS Secretary Kathleen Sebelius. “Our efforts strengthen the integrity of our healthcare programs and meet the president's call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”

The $4.1 billion recouped has been paid back to either the U.S. Treasury or the Centers for Medicare and Medicaid Services, transferred to other federal agencies that administer healthcare programs, or been paid to private individuals who were victims of fraud, the government says.

The newer fraud protection practices are making in-roads in curbing healthcare fraud, but remain only a stepping stone towards eliminating rampant healthcare fraud, a problem that the government has said accounts for nearly 10 percent of all Medicare claims.


February 17, 2012
http://www.burrillreport.com/article-feds_recoup_4_1_billion_in_healthcare_fraud.html