California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Federal Health Care Fraud Probes Brought in Record $4.2B Last Year

The federal government recouped a record $4.2 billion through health care fraud investigations in 2012, according to a report released Monday by the Department of Justice and HHS, The Hill's "Healthwatch" reports (Baker, "Healthwatch," The Hill, 2/11).

The recovered funds came from the more than 1,100 criminal health care fraud investigations and 900 civil investigations launched in 2012. More than 800 individuals were convicted of fraud-related crimes in the criminal cases. 

Overall, the Health Care Fraud and Abuse Program has recovered more than $23 billion in Medicare funds since it was created in 1997 (AP/Modern Healthcare, 2/11). Recent efforts have increased the amount of fraudulent payments the federal government has recaptured. 

For example, HCFAP has recovered $14.9 billion in the last four years, more than twice the $6.7 billion it recouped in the four years prior. The report also noted that for every dollar spent investigating fraud in Medicare and Medicaid over the last three years, the federal government recouped $7.90, which is the highest three-year average return since HCFAP's inception (Kelly, Reuters, 2/11). 

The report credited the uptick to an antifraud task force created in 2009 and noted that the Affordable Care Act also will boost antifraud efforts ("Healthwatch," The Hill, 2/11).

An estimated $60 billion is lost each year to Medicare fraud (Terhune, "Money & Co.," Los Angeles Times, 2/11).

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