$125 million SNF settlement contributes to $1 billion bump in fraud recoveries
The HCFAC program recovered a total of $3.3 in FY 2016, according to the report
The $125 million settlement by Kindred Healthcare Inc. and a $30 million settlement with North American Health Care over therapy claims are counted among recoupments by the federal government that totaled $3.3 billion in fiscal year 2016.
The Health Care Fraud and Abuse Control Program's annual report, released Wednesday, highlights how much the federal government takes back through fraud and abuse cases in a given year. The efforts of the Department of Health and Human Services and the Department of Justice resulted in an increase of nearly $1 billion over last year's recovery total of $2.4 billion. That was despite continued sequestration that cut $20.6 million in funding from the HCFAC program.
Over the course of FY 2016, federal healthcare fraud investigations led to 765 criminal and 690 civil actions. This includes the indictment of Philip Esformes, a Miami nursing home owner believed to be the ringleader of a $1 billion Medicare scheme.
Esformes' trial in the case — which stands as the largest single criminal healthcare case ever handled by the DOJ — is slated to begin in September 2017.
Last year the government excluded nearly 4,000 individuals and entities from federal healthcare programs, with the majority of those resulting from Medicare and Medicaid-related crimes, according to the report.