Healthcare Business News

Anti-fraud efforts recovered $2.5 billion, feds say

By Gregg Blesch
Posted: May 13, 2010 - 6:00 pm ET

The government's efforts to rein in Medicare fraud and abuse recovered $2.5 billion for the program in fiscal 2009, up 29% from $1.9 billion the previous year, according to a new annual report.

HHS Secretary Kathleen Sebelius and Attorney General Eric Holder touted that number and others as evidence that the Obama administration's invigorated attention to the problem has paid dividends already, and they highlighted new funding and tools their departments will wield in the fight.

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The $2.5 billion collected in fiscal 2009 is attributed to judgments and settlements in previous years as well as 2009, according to the report of the Health Care Fraud and Abuse Control Program. Another $441 million was returned to the treasury as the federal share of Medicaid recoveries.

In the criminal realm of healthcare fraud in fiscal 2009, the Justice Department opened 1,014 new investigations compared with 953 in fiscal 2008. Prosecutors charged 803 defendants and won 583 convictions. Those numbers don't differ significantly from the previous year.

“We have seen over the years that as long as healthcare fraud pays and goes unpunished, our healthcare system will remain under siege,” Holder said at a joint news conference with Sebelius. “We're fighting back,” Holder said.

The new Patient Protection and Affordable Care Act steers an additional $350 million toward fighting fraud over the next 10 years. Other provisions aimed at fraud and abuse include stiffer sentences for criminal offenses, enhanced screening for provider enrollment and better access to CMS claims data for law enforcement officials and HHS' inspector general's office.



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