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Healthcare fraud investigations recover $4.3B in FY 2013


By Paul Demko
Posted: February 26, 2014 - 12:01 am ET
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The federal government recovered $4.3 billion through healthcare fraud investigations in fiscal 2013, according to a report (PDF) released Wednesday by HHS and the Department of Justice. That's up from $4.2 billion in recovered assets during the prior year.

During the past four years, the Health Care Fraud and Abuse Control Program has collected $19.2 billion—more than double the amount in the prior four years.

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“We're sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations and commit fraud on federal healthcare programs,” Attorney General Eric Holder said in a statement regarding the recoveries.

Roughly two thirds of the funds recovered in fiscal 2013—$2.9 billion—went to the Medicare Trust Funds. An additional $1.2 billion in fraud settlements, recoveries and penalties went to the CMS. The remainder was split between other federal agencies and individuals who were victims of fraud.

In 2013, DOJ opened 1,013 criminal healthcare fraud investigations involving 1,910 individuals. In total, there were 2,041 pending investigation involving more than 3,500 individuals at the close of fiscal year 2013. In addition, a total of 718 defendants were convicted of healthcare fraud charges during the year.

Also in 2013, investigations conducted by HHS' Office of the Inspector General resulted in 849 criminal prosecutions that stemmed from Medicaid or Medicare fraud. Those investigations also led to 458 civil lawsuits.

In particular, federal officials hailed the success of Medicare Fraud Strike Force teams operating in nine areas across the country. In fiscal 2013, strike force activities resulted in charges against 345 individuals and 280 criminal convictions, according to the report. Of those defendants sentenced in 2013, the average prison term was 52 months.

The federal agencies spent nearly $600 million on fraud investigations during fiscal year 2013. Cuts stemming from sequestration reduced that budget by roughly $30 million. The average return on investment for fraud investigations from 2011 to 2013 was $8.10 per $1 spent.

Follow Paul Demko on Twitter: @MHpdemko


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