HHS Recovered $3.3 Billion in Fraudulent Healthcare Payments in 2014

More than $3 billion was returned to the Medicare Trust Fund in 2014 from individuals and companies attempting to defraud federal health programs, according to an announcement by HHS.

Overall, since the Health Care Fraud and Abuse Control program was created in 1997, it has recovered more than $27.8 billion, and over the last 3 years, the administration has recovered $7.70 for every $1 spent.

“These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of health care fraud and prevent future fraud and abuse,” Secretary Burwell said in a statement. “New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door. And together with the continued support of Congress and our partners at the Department of Justice, we’ve cracked down on tens of thousands of health care providers suspected of Medicare fraud—all of which are helping to extend the life of the Medicare Trust Fund.”

The Affordable Care Act (ACA) granted new authorities the ability to target fraudsters in order to prevent healthcare fraud and abuse in the first place. According to HHS, the government has also changed how it fights certain types of healthcare fraud. By investigating through real-time data analysis, as opposed to a prolonged subpoena and account analyses, the time between fraud identification and arrest and prosecution has been shortened.

CMS has put in place safeguards to ensure only legitimate providers are enrolling in the program. As required by the ACA, CMS must revalidate all 1.5 million Medicare suppliers and providers under new screening requirements. CMS has deactivated 470,000 enrollments and revoked nearly 28,000 enrollments to prevent providers from re-enrolling and billing Medicare.

The Fraud Prevention System in place by CMS saved $210.7 million in its second year, according to HHS.

“The extraordinary return on investment we've obtained speaks to the skill, the tenacity, and the inspiring success of the hardworking men and women fighting on behalf of the American people,” Attorney General Eric Holder said. “And with these outstanding results, we are sending the unmistakable message that we will not waver in our mission to pursue fraud, to protect vulnerable communities, and to preserve the public trust.”