Federal efforts in the area of healthcare fraud prevention and enforcement led to the recovery of $4.3 billion in taxpayer funds during fiscal year 2013, according to the annual Health Care Fraud and Abuse Control (HCFAC) Program report.
The recovery was up slightly from the $4.2 billion recouped in fiscal year 2012 and represents the fifth consecutive year that the total amount returned to government coffers exceeded the previous year’s amount. According to the report, the government has recovered $8.10 for every dollar spent on healthcare-related fraud and abuse investigations over the past three years.
HCFAC is a joint program of the Department of Justice and the Department of Health and Human Services. Since its founding in 1997, the program has returned almost $26 billion to the Medicare Trust Fund and the U.S. treasury, according to federal officials.
In a February 2014 statement, U.S. Attorney General Eric Holder said the report’s findings send “a strong message to those who would take advantage of their fellow citizens, target vulnerable populations and commit fraud on federal health care programs.”
According to the report, the Department of Justice opened about 1,000 new criminal investigations related to healthcare fraud during FY2013. Federal prosecutors had more than 2,000 criminal cases related to healthcare fraud pending during the year and filed charges in 480 cases involving 843 defendants.
Meanwhile, 718 defendants were convicted of criminal charges related to healthcare fraud in 2013. FBI investigations into healthcare fraud resulted in the disruption of 425 criminal fraud organizations and the dismantling of the hierarchy of 115 criminal enterprises, according to the report.
The Justice Department and Health and Human Services formed the Health Care Fraud Prevention and Enforcement Team (HEAT) in 2009 to better counter fraud and waste in the Medicare and Medicaid programs.
In fiscal year 2013, HEAT initiatives scored several major victories, including an action by the Medicare Fraud Strike Force in seven cities that led to charges against 91 medical professionals. The case involved allegations of home healthcare fraud totaling more than $230 million, as well as ambulance transportation fraud exceeding $49 million and at least $100 million in mental healthcare fraud. Thirty healthcare providers also were suspended or faced administrative action, according to HHS.
A second HEAT initiative led to charges against 89 people, including nurses and doctors, for their alleged participation in schemes to defraud Medicare of more than $220 million.