Fraud program posts record-breaking year

Wednesday, February 26, 2014

WASHINGTON – The Health Care Fraud and Abuse Control Program recovered $4.3 billion in fiscal year 2013 and $19.2 billion in the last five years.

That’s up from $4.2 billion in fiscal year 2012 and $9.4 billion in the previous five years, according to an annual report released Feb. 26.

“These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” said Department of Health and Human Services (HHS) Secretary Kathleen Sebelius in a release. 

A highlight from 2013: Strike Force teams coordinated a takedown in eight cities against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings.

In 2013, the Department of Justice (DOJ) also opened 1,013 new criminal and 1,083 new civil healthcare fraud investigations, and helped to convict 718 defendants of healthcare fraud-related crimes.

Also as part of fraud prevention efforts, CMS has been revalidating 1.5 million enrolled providers and suppliers under Affordable Care Act screening requirements. As of September 2013, CMS has revoked the ability of 14,663 providers and suppliers to bill Medicare.