Monday, March 14, 2011

The feds recovered over $4 Billion in 2010 from health care fraudsters is reporting on the the significant recoveries ($4B) by the feds from health care fraudsters (story below).  But in relation to the entire government health care budget ($1T), and considering the Government concedes that at least 10% of the Medicare budget is lost through of fraud, the recoveries in FY 2010 are a drop in the bucket.  Some good work yes (kudos to OIG, DoJ, DCIS, NAMFCU, AGs, and others), but $4B out of $1T is like you and I saving for the kids college by looking for loose change in the couch.  Also keep in mind, most of the recoveries were due to whistleblowers,      
A new report shows that the federal government recovered more than $4 billion in Fiscal Year (FY) 2010 from health care fraud prosecutions and settlements – the largest annual amount ever recovered in health care fraud cases.  The federal government pointed to the expansion of Medicare Fraud Strike Force teams as one reason for the increased recovery.  In FY 2010, the total number of cities with strike force prosecution teams was increased to seven, all of which have teams of investigators and prosecutors dedicated to fighting fraud.  The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers.   Strike force enforcement accomplishments in all seven cities during FY 2010 include:
  • 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million;
  • 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants; and
  • 146 defendants were sentenced to prison during the fiscal year, averaging more than 40 months of incarceration.
Including strike force matters, federal prosecutors opened 1,116 criminal health care fraud investigations as of the end of FY 2010, and filed criminal charges in 488 cases involving 931 defendants.   A total of 726 defendants were convicted for health care fraud-related crimes during the year.

In addition to these criminal enforcement successes, 2010 was a record year for recoveries obtained in civil health care matters brought under the False Claims Act—more than $2.5 billion, which was the largest in the history of the Department of Justice, according to the government.

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