Fraud efforts recover $3.3B

Friday, March 20, 2015

WASHINGTON – The government’s healthcare fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in fiscal year 2014, the Justice and Health and Human Services departments announced March 19. For every dollar spent on health care-related fraud and abuse investigations in the last three years, the government has recovered $7.70—the third highest return on investment since the Health Care Fraud and Abuse Control Program was established in 1997, according to the agencies. In all, more than $27.8 billion has been returned to the Medicare Trust Fund over the life of the program, they say.



The government narrative of lumping "fraud" with "overpayments" and "abuse", all under the banner of fraud needs to change.  This is a discussion I have at every opportunity with State and Federal payers / regulators.  This is especially true in light of RAC audits, where two private entities are pitted against each other, one looking for any opportunity for a "gottcha", so that they can hold the hammer of fraud and abuse over the provider's head.  

As an industry, it's really important to actively promote the change of this terminology.  Putting providers in this light does not help anyone, especially providers who despite a strong focus on care, quality and compliance, still find themselves in battles over technical details and arguments over regulatory semantics.