DoJ, HHS Recovered $4.3 Billion in Fraud in '13

Magnifying glassBy Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO
The Federal Health Care Fraud and Abuse Control Program, “a joint project” of the Justice Department and the Department of Health and Human Services (HHS), “recovered a record $4.3 billion” for fiscal year 2013, “up from $4.2 billion in 2012.” That amounted to $8.10 “for every dollar spent investigating healthcare fraud and abuse in the last three years.” Since its launch in 1997 the initiative has recovered “nearly $26 million” for the Medicare Trust Fund and the United States Treasury. In a statement, HHS Secretary Kathleen Sebelius said, “We’ve cracked down on tens of thousands of health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results – all of which are adding to savings for the Medicare Trust Fund.” McClatchy (2/27, Pugh, Subscription Publication)
The Washington Times (2/27, Howell) quotes Attorney General Eric Holder, who said, “With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive health care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal health care programs.”

Brad Ericson
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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

No Responses to “DoJ, HHS Recovered $4.3 Billion in Fraud in '13”

  1. Juddi Schneider says:

    I think it is probably just a typo, but if DOJ recovered 4.3 billion for fiscal year 2013, shouldn’t the total recovered since 1997 be 26 billion and not 26 million as stated above?

  2. Deborah Powers, CPC says:

    Indeed. You are correct.

  3. Janet Hawkins, CPC says:

    That is great. But, much of the recovered money is due to careless payments issued by Medicare and third party payers who never bothered to investigate who they were paying. The millions recovered to DME’s are a great example. Empty storefronts receiving payments. As a result providers who are honest are being punished by RAC and Medicare by paying out hundreds of thousands of dollars just trying to hang on to their legitimate payments where absolutely no fraud or error happened. I know, that is my job to fight over keeping or getting back dollars that are legitimate. Providers backs are being broken by government demands to use EMR (now proven to be useless as far as convenience goes), hiring more staff to recover the money not in error. I feel our government has created a greed fest with RAC, they are so motivated to get their dollars and phone calls to them usually yield an answer of “I don’t know, we are only processing what Medicare gives us, call Medicare”. I know, I talk to them every day. Sad…….