WASHINGTON–The Departments of Justice and Health and Human Services announced today the recovery of $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011.

In making the announcement today, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius said in a news release that for every dollar spent on healthcare-related fraud and abuse investigations in the last three years, the government recovered $7.90, noting that it was the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Control (HCFAC) Program.

Today’s news comes on the heels of a report issued late last week in which the Centers for Medicare & Medicaid Services (CMS) reported that in FY 2011, recovery auditors had identified and corrected 887,291 claims for improper payments, resulting in $939.3 million in improper payments being corrected.

The total corrections identified include $797.4 million in overpayments and $141.9 million in underpayments repaid to providers and suppliers. CMS noted in its report, “Recovery Auditing in the Medicare and Medicaid Programs for Fiscal Year 2011,” that, “after taking into consideration all fees, costs, and appeals,” the program returned $488.2 million to the Medicare Trust Fund.

In today’s report on the Health Care Fraud and Abuse Control (HCFAC) Program, the government said that its healthcare fraud prevention and enforcement efforts during the last four years have recovered $14.9 billion, up from $6.7 billion over the prior four-year period. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds.

The news release, distributed today, credits the success to the joint Department of Justice and HHS effort made possible by the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The Team was created in 2009 to prevent fraud, waste, and abuse in the Medicare and Medicaid programs and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with new tools and resources provided by the Affordable Care Act.

About $4.2 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury, and others in FY 2012.

The government said new authorities under the Affordable Care Act granted to HHS and CMS were instrumental in clamping down on fraudulent activity in healthcare. In FY 2012, CMS began the process of screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system that quickly identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation to verify the data. As a result, nearly 150,000 ineligible providers have already been eliminated from Medicare’s billing system.

From May 2011 through the end of 2012, more than 400,000 providers were subject to the new screening requirements, and nearly 150,000 lost the ability to bill the Medicare program due to the Affordable Care Act requirements and other proactive initiatives, according to today’s news release.

Today’s report follows a report made public last week from the bipartisan U.S. Senate Committee on Finance, that released recommendations to curb waste, fraud, and abuse. The reported, dated Jan. 31, 2013, highlights a number of recommendations submitted by individual healthcare stakeholders, including suggestions from RACmonitor readers. Healthcare attorney Andrew Wachler, principal of Wachler and Associates, solicited comments from various stakeholders and forwarded them to the committee.

“We worked with the Payment and Reimbursement Subsection of the Health Law Section of the American Bar Association to coordinate comments of our clients and other lawyers and submitted them to Kimberly Brandt, Investigative Counsel for the Senate Finance Committee,” Wachler said.

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Chuck Buck is publisher of RACmonitor.

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The HCFAC annual report is available at www.oig.hhs.gov/publications/hcfac.asp.

Senate Finance Committee Report

FY 2011 Report to Congress

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