$3.3B in Fraudulent Health Care Payments Recouped in FY 2014

The Obama administration in fiscal year 2014 recovered $3.3 billion in fraudulent health care payments, HHS and the Department of Justice announced Thursday, the Wall Street Journal reports.

According to HHS, the administration has recovered $7.70 for every $1 spent looking into potential health care-related fraud and abuse over the past three years.

In addition, the administration has reduced the amount of time that lapses between when fraud is first identified and when arrests are made in the cases, according to the Journal.

Further, the administration's focus on preventing fraud instead of responding to it under the Fraud Prevention System in FY 2013:

• Generated 469 leads for investigations;
• Pinpointed or prevented about $211 million in incorrect payments; and
• According to the Journal, that amount was almost double the amount found in FY 2012, the first year the system was used.

In FY 2014, DOJ:

• Convicted 734 defendants of health care fraud-related crimes;
• Filed criminal charges in 496 health care fraud cases involving 805 defendants; and
• Opened 924 investigations into criminal health care fraud.

Overall, the Medicare Trust Fund has recovered more than $27.8 billion through the fraud and abuse program since it began in 1997. The funds have come from individuals and organizations that made fraudulent claims in federal health programs, including Medicaid and Medicare.

According to the Journal, 10% of Medicare's annual spending, or about $58 billion in FY 2013, is from fraudulent claims (Armour, Wall Street Journal, 3/19).