HHS Collects Record Amount in Fraud Repayments

Jan. 27, 2011— -- WASHINGTON -- The Department of Health and Human Services (HHS), in a joint effort with the Justice Department, recouped more than $4 billion through fraud prevention and enforcement efforts in fiscal 2010, officials announced this week.

"Our aggressive pursuit of healthcare fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department," U.S. Associate Attorney General Thomas Perrelli said in a statement.

The recovered funds were returned to the Medicare Health Insurance Trust Fund, the Treasury, and other departments.

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The operation was implemented through a joint HHS-Justice Department program called the Health Care Fraud and Abuse Control Program (HCFAC), which coordinated federal, state, and local law enforcement fraud-fighting activities. The Affordable Care Act is providing $350 million for HCFAC activities.

Medicare Strike Force teams, which are located in seven cities nationwide, use data analysis to identify high billing levels in healthcare fraud hot spots to target for investigation and possible prosecution.

Strike Force enforcement accomplishments in all seven cities last year included:

Fiscal 2010 also produced a record amount of recoveries in civil suits filed under the False Claims Act -- more than $2.5 billion.

HHS also announced publication of a final rule outlining additional healthcare fraud enforcement measures being enacted as part of the ACA.

These include creating a rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP); requiring a new enrollment process for Medicaid and CHIP providers; enabling Medicare and state agencies to temporarily stop new provider enrollment if computer models detect possible fraud issues; and temporarily stopping payments to providers and suppliers who are suspected of fraud.