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Fed Recovers $4.2 Billion in Health Care Fraud

The federal government in the last 36 months has been able to recover $7.90 for every dollar it spent investigating health care fraud, according to a report by Medical News Today. Information showing the savings was released by the Department of Health and Human Services (HHS) Secretary Kathleen Sibelius and U.S. Attorney General Eric Holder.

The favorable results indicate the government has improved its efforts to prevent health care fraud and enforce penalties against it, the Justice Department and HHS said. In 2012 the agencies said the recovery of $4.2 billion is an increase from the $4.1 billion recovered in 2011.

The government recovered the money from persons and companies that defrauded health care programs for seniors and general taxpayers.

In the last four years, a total of $14.9 billion have been recaptured. That compares to a recovery of $6.7 billion in the four years before that.

“Our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off,” said Sibelius. “We are gaining the upper hand in our fight against health care fraud. This fight against fraud strengthens the integrity of our health care programs and helps us fulfill our commitment to our seniors.”

Since the Health Care Fraud and Abuse Program (HCFAC) started in 1997, it has recovered more than $23 billion for the Medicare Trust Funds.

In Fiscal Year 2012 the federal government has won or negotiated over $3.0 billion in fraud judgments and settlements.

The money recovered is the result of President Obama’s efforts to eliminate waste, fraud and abuse in health care and other areas the government oversees, according to HHS. In 2009, the government formed the Health Care Fraud Prevention and Enforcement Team (HEAT) to investigate and bring to justice those who commit fraud.

HHS reported that the Affordable Care Act has enabled:

  • Improved sharing of data among government agencies
  • Better ways to screen and enroll clients
  • Greater efforts to recover fraudulently acquired money
  • Closer monitoring of private insurance abuses

By sharing information, teams from different agencies can identify and prosecute schemes as they arise. In addition, they can detect those committing fraud over many years while pretending to be honest health care suppliers or providers. The government began to use the same technique used by credit card companies, called predictive modeling, to help recognize fraudulent claims before they are paid.

In 2012, a program was begun to enhance communication among prominent health insurance groups, state and federal officials, and anti-fraud agencies to identify scams. The Justice Department last year began 1,131 new criminal health care fraud investigations. There were 826 persons charged and convicted of health care fraud-related crimes in 2012 and 885 new civil investigations started.

In 2012, 107 persons committing fraudulent Medicare billings were caught in a scheme perpetrated by doctors, nurses and others in seven cities. Their fraudulent billings totaled about $452 billion.


Medical fraud is a terrible thing. To speak with a Connecticut medical malpractice lawyer for more information, or if you would like to report fraud and talk to an attorney about your legal options, contact Berkowitz and Hanna LLC today.