The federal government won $5 billion in healthcare fraud judgments against providers last fiscal year, a staggering increase after a COVID lull.
That’s according to the Health Care Fraud and Abuse Control Program Annual Report, which is filed annually by the Department of Health and Human Services and The Department of Justice.
The enforcement haul is up from $1.8 billion in fiscal 2020, when COVID-19 closed courtrooms nationwide and otherwise delayed investigations and prosecutions. More significantly, it’s more than double the amount clawed back in fiscal years 2017, 2018 and 2019, which averaged about $2.4 billion in verdicts and settlements annually.
The $5 billion in judgments, settlements and administrative impositions were the result of a variety of enforcement programs run by the DOJ and the HHS Office of Inspector General, as well special units that bring together other federal and state entities to prosecute complex healthcare crimes. In 2021, they targeted drug diversion and COVID-related fraud. In one COVID action alone, a strike force investigation led to charges against 14 defendants in seven federal districts for schemes that exploited the pandemic and resulted in more than $143 million in false billings.
Overall, Justice opened 831 new criminal healthcare fraud investigations and prosecutors filed criminal charges in 462 of them. A total of 312 defendants were convicted of healthcare fraud related crimes during the year, the report said.
The DOJ also opened 805 new civil health care fraud investigations and had 1,432 civil health care fraud matters pending at the end of the fiscal year.
In the same year, HHS OIG investigations led to 504 criminal actions against individuals or entities for Medicare- or Medicaid-related crimes. They also undertook 669 civil actions, which include false claims and civil monetary penalty settlements.
Of the $5 billion netted in judgments or settlements, about $1.9 billion was returned to the federal government or private persons. Of that, about $1.2 billion went back to the Medicare Trust Funds.
Among nursing and residential care takebacks noted in the report were an $11.2 million settlement with SaveSeniorCare over False Claims allegations; a $214,000 repayment for Medicaid funds by Texas-based Care Initiatives, over claims of inadequate COVID-19 infection precautions for a 10-week period at Dubuque Specialty Care; and an $8.4 million agreement with Select Medical Corporation to recoup False Claims made for rehab services at 12 SNFs in New York and New Jersey over a six-year period.
The report estimated the return-on-investment for the 25-year old enforcement reporting program at $4 for every $1 spent.
