2011 Healthcare Fraud Recovery Largest Ever
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: February 14, 2012
WASHINGTON -- The federal government recovered $4.1 billion in fraudulent healthcare payments in fiscal 2011, the largest amount ever collected in a single year, federal officials announced Tuesday.
Ramped-up fraud-fighting efforts led to a 50% increase from 2009 to 2011 in judgments and settlements of payments fraudulently obtained from Medicare and Medicaid, according to the Justice Department and the Department of Health and Human Services (HHS).
The payback results from another record number: criminal charges were filed against 1,430 defendants for healthcare fraud-related crimes, according to HHS.
A total of 743 defendants were convicted during the year, HHS said. The cases included durable medical equipment fraud; illegal marketing of medical devices or drugs for uses not approved by the FDA, including unlawful pricing by drugmakers; and violations of self-referral and anti-kickback laws.
Much of the success stemmed from the Health Care Fraud Prevention & Enforcement Team (HEAT), a task force created in 2009 to prevent fraud, and the Medicare Fraud Strike Force teams.
Those teams use data analysis to identify high billing levels in healthcare fraud hot spots -- such as Detroit and Miami -- to target for investigation and possible prosecution. In 2011, the teams added Chicago and Dallas to their "hot spot" list, which brought the total number of targeted cities to nine, including Los Angeles, Houston, Brooklyn, N.Y., Baton Rouge, La., and Tampa, Fla.
"Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars," said HHS Secretary Kathleen Sebelius in a press release. "Our efforts strengthen the integrity of our healthcare programs and meet the president's call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules."
The Affordable Care Act includes $350 million in healthcare fraud-fighting funds. One new provision in the law requires those providers and suppliers wishing to participate in Medicare, Medicaid, and the Children's Health Insurance Program that have been deemed to be at higher risk of fraud or abuse to undergo licensure checks and site visits to confirm legitimacy.
The $4.1 billion was either paid back to the U.S. Treasury or to the Centers for Medicare & Medicaid Services, transferred to other federal agencies that administer healthcare programs, or paid to private persons who were the victims of Medicare fraud.
Since the Health Insurance Portability and Accountability Act established a national healthcare fraud and abuse program in 1997, $20.6 billion has been paid back to the Medicare program.
A government report from 2011 found that nearly 10% of all Medicare payments go toward fraudulent claims.
Today 2/15/12 at 10 ET the House Energy and Commerce Committee/Subcommittee on Health will be discussing Reauthorization of MDUFA: What It Means for Jobs, Innovation and Patients. The #1 expenditure of Medicare is joint replacement and the IOM 7/29/11 reported that the FDA mechanism for clearing implanted medical devices - 510(k)- is legislatively flawed and should be scrapped. Victims of failed implanted medical devices are in medical and legal purgatory and our economy is in peril as a result of these expensive mistakes. Innovation does not equate success. Our economy will be sustainable when citizens have jobs that enhance our nation. The medical industry does not get a "pass". It is revealing that "patients" are mentioned last-again!