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Healthcare fraud task force recovers nearly $28 billion, HHS says

This year alone, prevention and enforcement efforts recovered $3.3 billion.

Susan Morse, Senior Editor

This year alone, prevention and enforcement efforts recovered $3.3 billion from individuals and companies that attempted to defraud federal health programs serving seniors, persons with disabilities or those with low incomes.This year alone, prevention and enforcement efforts recovered $3.3 billion from individuals and companies that attempted to defraud federal health programs serving seniors, persons with disabilities or those with low incomes.

The federal crackdown on healthcare fraud has resulted in more than $27.8 billion being returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control Program, Attorney General Eric Holder and Department of Health and Human Services Secretary Sylvia M. Burwell announced Thursday.

This year alone, prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars from individuals and companies that attempted to defraud federal health programs serving seniors, persons with disabilities or those with low incomes.

[Also: Running list of notable 2015 healthcare frauds]

A Medicare Strike Force has prosecuted over 2,000 defendants who have fraudulently billed the Medicare program of more than $6.5 billion, HHS said in the announcement.

In 2014, 734 defendants were convicted of healthcare fraud-related crimes.

Increased funding from the administration and Congress has allowed fraud prevention to expand into nine geographic territories: Miami; Los Angeles; Detroit; Houston; Brooklyn, New York; Southern Louisiana; Tampa, Florida; Chicago; and Dallas.

These recovery efforts are due in part to new authorities granted by the Affordable Care Act, according to Burwell. The administration has moved away from “pay and chase” efforts targeting fraudsters to preventing health care fraud and abuse in the first place.

For every dollar spent on health care-related fraud and abuse investigations in the last three years, the administration recovered $7.70, according to the release. This represents the third-highest return on investment since the program’s inception in 1997.

[Also: Medicare penalizes 721 hospitals over medical errors [full list]]

In addition, the Health Care Fraud Prevention and Enforcement Action Team, run jointly by the HHS Office of the Inspector General and Department of Justice, is changing how the federal government fights certain types of healthcare fraud. These cases are being investigated through real-time data analysis in lieu of a prolonged subpoena and account analyses, resulting in significantly shorter periods of time between fraud identification, arrest, and prosecution, according to the announcement.

Civil settlements recovered $2.3 billion last year. Since 2009, the Justice Department has recovered more than $15.2 billion in federal civil cases involving healthcare fraud.  In many of these cases, the department has been instrumental in recovering additional billions for state healthcare programs.

CMS has also put additional safeguards in place to make sure only legitimate providers are enrolling in the Medicare program. The ACA required a CMS revalidation of all existing 1.5 million Medicare suppliers and providers. As a result, CMS has deactivated 470,000 enrollments and revoked nearly 28,000 enrollments to prevent certain providers from re-enrolling and billing the Medicare program.

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CMS has also issued a regulation requiring prescribers of Part D drugs to enroll in Medicare and undergo screening. It also continues the temporary freeze on the enrollment of new home health or ambulance service providers in six fraud hot spots: Miami, Chicago, Dallas, Houston, Detroit and Philadelphia, which includes some counties in New Jersey.

CMS’s Fraud Prevention System, now in its second year, the has saved $210.7 million, almost double the amount identified during the first year of the program.

Eliminating fraud, waste and abuse helps extend the life of the Medicare Trust Fund, Burwell said.

“With these outstanding results, we are sending the unmistakable message that we will not waver in our mission to pursue fraud, to protect vulnerable communities, and to preserve the public trust,” Attorney General Holder said in a statement.

Twitter: @SusanMorseHFN

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