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Feds recover $4.1 billion from 2011 Medicare fraud-busting efforts

by Brendon Nafziger, DOTmed News Associate Editor | February 14, 2012
HHS Secretary Kathleen Sebelius
Federal officials said they recovered more than $4.1 billion from Medicare and Medicaid fraud-busting efforts in fiscal 2011.

“This is an unprecedented achievement, and represents the highest amount recovered in a single year,” Attorney General Eric Holder told reporters Tuesday in a conference announcing the latest Health Care Fraud and Abuse Control Program Report.

According to the report, the government won or negotiated $2.4 billion in health care fraud judgments last fiscal year. With other fees and results from previous years, they ultimately deposited $4.1 billion with the Treasury Department or the Centers for Medicare and Medicaid Services. The Medicare Trust Fund got about $2.5 billion, the government said.

Holder said last year federal officials opened 1,100 criminal health care fraud investigations, charging more than 1,400 and convicting more than 700. The DOJ also opened nearly 1,000 new civil cases, and netted $2.4 billion under the False Claims Act, Holder said.

The Health Care Fraud and Abuse Control Program report said every dollar invested in Medicare fraud-fighting efforts returned $7.2 to tax payers on average for the past three years. The return on investment since the program’s inception in 1997 is $5.1 for every dollar spent, the report said.

“Going after health care fraud continues to be one of the best investments we can make as a country,” Department of Health and Human Services Secretary Kathleen Sebelius said at the press conference.

Federal officials credited some of their success to work by nine so-called strike force teams, joint DOJ and HHS operations that target fraud “hot spots,” such as Miami and Detroit, where Medicare and Medicaid scams are unusually prevalent.

Other strike force cities include Los Angeles, Houston, New York, Baton Rouge, Tampa, Chicago and Dallas.

Sebelius said the department hoped to use some of the additional $300 million discretionary funding they requested in the 2013 fiscal budget to pay for new strike force teams in other hot spot cities, although she said the department has a policy of not naming future targets.

“We don’t name the next possible cities,” she said. “We’re constantly looking at the predictive modeling data, and that determination is made by errant billing practices.”

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