Joint HHS, Justice efforts recoup $28 billion in Medicare payments

The Justice Department announced on Thursday it had captured $3.3 billion from healthcare fraud prosecutions and other deals in 2014, bringing to nearly $28 billion the total amount it has recouped since the beginning of its 18-year-old Health Care Fraud and Abuse Control (HCFAC) Program.

In recent weeks, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services have been the targets of open criticism for not recouping more overpayments from Medicare providers and contractors.

Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell jointly announced that $27.8 billion has now been returned to the Medicare Trust Fund. The HCFAC Program roots out and prevents fraud in federal health programs serving seniors, the disabled and the poor.

Holder and Burwell also lauded efforts by CMS to place tighter safeguards to ensure “only legitimate providers are enrolling in the [Medicare] program.” Some 450,000 provider enrollments had been deactivated and nearly 27,000 enrollments revoked to prevent them from re-enrolling since 1997.

The pair also announced that the administration has recovered $7.70 for every $1 spent on healthcare-related fraud and abuse investigations over the past three years. That's about $2 higher than the overall average ROI in the HCFAC program.

Burwell noted in the prepared statement that new enrollment screening techniques and computer analytics are preventing fraud “before money ever goes out the door,” adding that HHS has “cracked down on tens of thousands health care providers suspected of Medicare fraud.” False Claims Act cases and the expansion of the Medicare Strike Force into nine geographic territories have been two of the key reasons, she said.