February 17, 2012

Department of Justice & HHS Announce Record Recoveries in 2011

On February 14, 2012, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) published a Report (a copy of which can be found here) touting recoveries of “[a]pproximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs” in fiscal year 2011. This announcement was accompanied by a Press Release, which is the source of the above quote. These recoveries are reportedly the efforts of the Health Care Fraud and Abuse Control Program (HCFAC), a joint program under the direction of the Attorney General and the Secretary of HHS. The Press Release states that this “unprecedented achievement” constitutes the “the highest annual amount ever recovered” from those who improperly obtained payments from federal health care programs.

Some of the notable statistics appearing in the joint Report include the following for fiscal year 2011:

  • The DOJ opened 1,110 new criminal health care fraud investigations involving 2,561 potential defendants;
  • There were a total of 1,873 pending health care fraud criminal investigations involving 3,118 potential defendants;
  • 743 defendants were convicted of health care fraud-related crimes;
  • Of the approximate $4.1 billion total recovery, roughly $2.4 billion was obtained through civil health care fraud cases brought under the False Claims Act;
  • The DOJ opened 977 new civil health care fraud investigations and had 1,069 civil health care fraud matters pending at the end of 2011;
  • FBI heath care fraud investigations disrupted the operation of 238 criminal fraud organizations and dismantled the criminal hierarchy of more than 67 criminal enterprises engaged in fraud; and
  • HHS excluded 2,662 individuals and entities from participating in federal health care programs, including exclusions based on criminal convictions related to Medicare and Medicaid (1,015), criminal convictions relating to other health care programs (233) and patient abuse/neglect (206), and as a result of license revocations (897).

The Press Release attributes the financial success of the HCFAC to “President Obama making the elimination of fraud, waste and abuse a top priority in his administration.” Looking forward, HHS and DOJ report that the Affordable Care Act offers additional tools and resources to fight fraud and which should enhance the efforts  of the HCFAC. Some of the specific resources and tools mentioned include “an additional $350 million for HCFAC activities … enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.”

This post was contributed by Kurt Bratten.