Editor's Choice Main Category: Medicare / Medicaid / SCHIP Also Included In: Litigation / Medical Malpractice Article Date: 12 Feb 2013 - 0:00 PST

Current ratings for: Health Care Fraud, Record $4.2 Billion Recovered In 2012, USA

Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder issued a report which showed that for every dollar the US government spent on health care-related fraud and abuse investigations over the last 36 months, it got $7.90 back. This is a record over a three-year period since the HCFAC (Health Care Fraud and Abuse) Program began sixteen years ago.

Is this huge haul a sign of better coordination among public authorities, or does it reflect an increase in criminality? The Justice Department and HHS believe it is a sign of the government's health care fraud prevention and enforcement efforts. $4.2 billion (2012) is an increase from $4.1 billion in 2011.

The money was recovered from companies and individuals who had tried to defraud federal health programs aimed at seniors and taxpayers for payments they were not entitled to receive. $14.9 billion have been recovered over the last four years, compared to $6.7 billion during the previous four-year period. Over $23 billion have been returned to the Medicare Trust Funds since 1997 by the HCFAC Program.

According to the Office of the Inspector General, US Department of Health & Human Services, during the fiscal year 2012:

HEAT (Health Care Fraud Prevention and Enforcement Action Team) was created in 2009 to fight fraud, abuse and waste in the Medicaid and Medicare programs, and to close in on people and entities which abuse the system and cost the American taxpayers billions of dollars.

Attorney General, Eric Holder, said:

HHS Secretary Sebelius said:

According to HHS, the Obama Administration is also using tools that the Affordable Care Act authorized to combat fraud, including better data sharing across government departments, enhanced screenings and enrollment requirements, expanded recovery efforts for excessive payments, and closer monitoring of private insurance abuses.

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Health Care Fraud, Record $4.2 Billion Recovered In 2012, USA