U.S. recovers $4.2 billion from healthcare fraud probes

U.S. recovers $4.2 billion from healthcare fraud probes: report

Mon Feb 11, 2013 3:33pm EST

(Reuters) - The Obama administration said on Monday that its efforts to combat fraud in the Medicare and Medicaid healthcare programs were paying off as the government recovered a record $4.2 billion in fiscal 2012 from individuals and companies trying to cheat the system.

For every dollar spent investigating healthcare fraud over the past three years, the government recovered $7.90, according to a report released on Monday by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.

This was the highest three-year average return on investment in the 16-year history of the federal Health Care Fraud and Abuse Program, the report said.
The Obama administration has stepped up investigations under the program, making the prevention of fraud and waste in healthcare a top priority. The Patient Protection and Affordable Care Act authorized additional tools to fight fraud, including tougher eligibility screening for Medicare providers, increased data sharing among government agencies and greater oversight of private insurance abuses.

Efforts to curb waste, fraud and abuse are also seen by administration officials as a means to control healthcare spending, as the White House and Congress prepare for the next round of deficit reduction talks.

HCA Holdings Inc, the largest for-profit hospital operator in the United States, said in August that federal authorities were investigating whether heart procedures performed at some of its facilities were medically necessary.

Federal spending for Medicare, Medicaid and other healthcare programs is expected to hit $885 billion this year, according to the nonpartisan Congressional Budget Office.

The $4.2 billion recouped in fiscal 2012 from those attempting to defraud federal healthcare programs, including Medicare for the elderly and Medicaid for the poor, was up from nearly $4.1 billion the year before.

Over the past four years, the administration's enforcement efforts have recovered $14.9 billion, more than double the $6.7 billion recouped over the prior four-year period.

http://www.reuters.com/article/2013/02/11/us-healthcare-fraud-idUSBRE91A0ZO20130211