Holder, Sebelius tout billions in healthcare fraud recoveries

The U.S. recovered $4 billion last year through healthcare fraud prevention and enforcement efforts, according to a report released Wednesday by Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius.

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The report says that the Health Care Fraud and Abuse Control Act (HCFAC) recovered more than $8 for every $1 it spent on healthcare fraud investigations over the last three years, the best ratio in the 17-year history of the program.

“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,” Holder said in a statement.

The joint effort between the Department of Justice and HHS has recovered more than $19 billion over the last four years, the agencies said.

In addition, the report said the agency strike forces filed 137 cases, charged 345 individuals, secured 234 guilty please, and won 48 trial convictions. All of these are record highs, according to the DOJ and HHS.

“These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” Sebelius said in a statement.

Around the time of the passage of the Affordable Care Act, President Obama launched initiatives aimed at rooting out waste and fraud in Medicare and Medicaid, saying that federal overpayments to doctors and hospitals, and other misallocated funds, should be recovered and redirected to patients.

“We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud,” Sebelius continued. “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.”

Still, the FBI says that the United States spends at least $80 billion a year in healthcare fraud.