Feds recover record $4 billion from fraudulent healthcare claims

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The U.S. departments of Justice and Health and Human Services recovered a total of $4 billion in fiscal 2010 from healthcare fraud cases prosecuted under the False Claims Act, according to a new report from the annual Health Care Fraud and Abuse Control Program. A record-breaking $2.5 billion came from fraud judgments backed by whistle-blowers and ramped up collection efforts, administration officials said. The balance was collected through administrative findings.

HHS Secretary Kathleen Sebelius attributes the recovery to those involved with the Health Care Fraud Prevention & Enforcement Action Team. The task force, HEAT, was created in 2009 to prevent waste, fraud and abuse within Medicare and Medicaid systems.These systems are the top two payers of nursing home care in the United States.

More than half of the money recovered came from drug companies, such as Novartis. The company pleaded guilty to illegally marketing the seizure drug Trileptal as a pain and psychiatric drug. Novartis agreed to pay $420 million back to the government.

The Patient Protection and Affordable Care Act provides resources for healthcare fraud prevention, including enhanced screenings and stricter enrollment requirements, expanded overpayment recovery efforts, and greater oversight of private insurance abuses, according to HHS officials.