$2.6B collected from healthcare fraud cases by HHS, DOJ

In fiscal year 2017, HHS and the U.S. Department of Justice (DOJ) recovered nearly $2.6 billion from settlements and judgments in healthcare fraud cases, with $1.4 billion being transferred to the Medicare Trust Funds.

The total recovered amount detailed in the agencies’ annual report for the Health Care Fraud and Abuse Control Program is lower than prior years—it recovered $3.3 billion in fiscal year 2014, for example—but HHS made the argument it represents a good return on investment of taxpayer funds, saying for every dollar spent on investigations, the government recovered $4.

“By holding individuals and entities accountable for defrauding our federal health programs, we are protecting the programs’ beneficiaries, safeguarding billions in taxpayer dollars, and, in the case of pill mills, helping stem the tide of our nation’s opioid epidemic,” HHS Secretary Alex Azar said in a press release.

By the report’s count, FY 2017 saw:

·         967 criminal healthcare fraud investigations opened by the DOJ

·         720 defendants charged in 329 cases

·         639 defendants convicted

·         948 new civil healthcare fraud investigations opened

·         1,086 civil cases pending at the end of the year

·         788 criminal actions due to HHS’ Office of the Inspector General (OIG) investigations

·         818 civil actions from OIG investigations

·         3,244 individuals excluded from federal healthcare programs

One of the largest investigations of the year was the annual “healthcare fraud takedown.” For FY 2017, the operation set a new record by charging 412 people with involvement in false billing schemes netting $1.3 billion. 120 of the defendants were charged with opioid-related crimes.

Schemes which increase opioid use have become a higher priority as deaths related to overdoses and abuse have increased across the country. Physicians operating “pill mills” out of medical offices as well as kickbacks paid by pharmaceutical companies to providers or pharmacies for promoting their drugs were named as some of the top fraudulent practices investigated in FY 2017, along with the more typical submissions of false claims to Medicare and Medicaid.

“These achievements are important, but the department's work is not finished,” U.S. Attorney General Jeff Sessions said in a statement. “We will keep up this pace and continue to prosecute fraudsters so that we can give financial relief to taxpayers.”