Gov't fraud efforts produce 'unprecedented' results

Thursday, February 16, 2012

WASHINGTON - Healthcare fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in fiscal year 2011, according to a new report.

The report, from the Health Care Fraud and Abuse Control Program (HCFAC), was released last week by the U.S. Departments of Justice, and Health and Human Services.

"This report reflects unprecedented successes by the departments in aggressively preventing and combating healthcare fraud, safeguarding previous taxpayer dollars and ensuring the strength of our essential healthcare programs," stated Attorney General Eric Holder in a release.

The departments credit President Obama, who has made eliminating fraud, waste and abuse a top priority in his administration; the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which was created in 2009 to prevent fraud in the Medicare and Medicaid programs; and the Medicare Fraud Strike Force.

In 2011, strike force operations resulted in charging a record number of 323 defendants, who allegedly collectively billed Medicare more than $1 billion. They also resulted in 172 guilty pleas, 26 convictions and 175 prison sentences. The average prison sentence in these cases was more than 47 months.

Including these operations, federal prosecutors filed criminal charges against 1,430 defendants for healthcare fraud-related crimes, the highest number in a single year in the DOJ's history.

The recently enacted Affordable Care Act provides additional tools and resources to help fight fraud, including an additional $35 million for HCFAC.

Read the report.



Too bad so much of it was related to DME fraud. Seriously, this industry is going to get pounded into smitherines due to a continued severe lack of self regulation. Fraud IS rampant whether the DME industry wants to recognize it or not. Previous industry efforts like the "13 Point Plan" are simply unrealistic and will necessitate stronger actions by CMS.