By otmseo on January 21, 2014

Health Care Fraud Recoveries on the Rise

medical-doctor-1314902-sThe United States Government recovered $4.9 billion in fiscal year 2012 and total of almost $39 billion in qui tam and non-qui tam false claims act cases since October 1, 1987.  These recoveries are part of the Government’s focus on eliminating fraud, waste, and abuse and are in part a direct result of the use of Health Care Fraud Prevention and Enforcement Action Teams (HEAT), which are a joint effort on the part of the Department of Justice (DOJ) and the Department of Health and Human Services (HHS).  Most of the money recovered from health care fraud is returned to the Medicare Trust Fund, the treasury and other agencies. 

The Health Care Fraud and Abuse (HCFAC) Program is a joint DOJ and HHS initiate to coordinate resources from federal, state and local entities to fight health care fraud, waste, and abuse.  The government is also using newly created tools, authorized by the Affordable Care Act, including data sharing across multiple government agencies, more aggressive efforts to recovery overpayments, and the increased oversight of private health insurance frauds.  These authorizations under the Affordable Care Act, allowed HHS and the Centers for Medicare and Medicaid Services (CMS) to screen 1.5 million Medicare enrolled providers through the Automated Provider Screening system that identifies ineligible providers and potential frauds.  This simple screening process identified and removed 150,000 ineligible providers from the Medicare system.  These Medicare Fraud Strike Force Teams use sophisticated data analysis to identify potential areas of fraud as well as identifying new or emerging fraud schemes.  In 2012, the Department of Justice opened up about 1,000 criminal health care fraud investigations, involving over 2,000 defendants along with over 800 new civil investigations.

In 2013, there were 93 new non-qui tam false claims act cases filed and 753 qui tam False Claims Act cases filed by relators or whistleblowers.  In 2013, non-qui tam case settled or obtained judgments of $829,912,477 while qui tam False Claims Act cases in which the Government intervened settled or obtained judgments of $2,870,141,363.  Judgments or settlements in non-intervened qui tam cases resulted in $127,795,019.  HHS, or health care fraud  related False Claims Act cases resulted in $2,676,997,834 and Department of Defense related False Claims Act cases resulted in $712,773,336 in settlements or judgments for FY 2013.  The majority of False Claims Act cases are filed by whistleblowers and the vast majority of moneys recovered are from cases in which the United States intervened or otherwise pursued the action. 

For more information regarding false claims act litigation or, health care fraud, contact Michael C. Rosenblat.