More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control Program, Attorney General Eric Holder and Health and Human Services Secretary Sylvia M. Burwell announced March 19. The government’s healthcare fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in Fiscal Year 2014 alone from individuals and companies that attempted to defraud federal health programs, including programs serving seniors, persons with disabilities or those with low incomes, according to the release. For every dollar spent on healthcare-related fraud and abuse investigations in the last three years, the administration recovered $7.70.
“Eliminating fraud, waste and abuse is a top priority for the Department of Health and Human Services,” Burwell said in the release. “These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of healthcare fraud and prevent future fraud and abuse. New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door.” Cracking down on Medicare fraud helps to extend the life of the Medicare Trust Fund, Burwell said.
The recoveries are part of a fraud and abuse strategy that abandons pay-and-chase efforts in favor of proactive efforts that prevent healthcare fraud and abuse. To fight certain types of healthcare fraud, the Health Care Fraud Prevention and Enforcement Action Team use real-time data analysis, which results in significantly shorter periods of time between fraud identification, arrest and prosecution, according to the release.
In addition, in 2014 the Civil Division of the Justice Department and the United States Attorneys’ Offices obtained $2.3 billion in settlements and judgments from civil cases involving fraud and false claims against federal healthcare programs such as Medicare and Medicaid.
The Centers for Medicare & Medicaid Services also is adopting preventive measures to combat fraud and abuse, such as initiating safeguards to ensure only legitimate providers are enrolling in the program. The Affordable Care Act required a CMS revalidation of all existing 1.5 million Medicare suppliers and providers under new screening rules. As a result of this and other proactive initiatives, CMS has deactivated 470,000 enrollments and revoked nearly 28,000 enrollments to prevent certain providers from re-enrolling and billing the Medicare program. A provider with deactivated billing privileges can reactivate at any time, and a revoked provider is barred from re-entry into Medicare for a period ranging from one to three years. CMS has also issued a regulation requiring prescribers of Part D drugs to enroll in Medicare and undergo screening.
For more information on fraud prevention under the ACA visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-03-19.html