Fight against health care fraud recovers $4.1B

WASHINGTON -- Investigators recovered a record-breaking $4.1 billion in health care fraud money during 2011, a reflection of the Obama administration's increased focus on fighting fraud, Justice Department officials announced Tuesday.

Between 2009 and 2011, the federal government has collected $7.20 for every dollar spent on fighting fraud, according to the Department of Health and Human Services (HHS) inspector general. That's a jump from the $5.10 for every dollar spent between 1997 and 2008, records show.

"It demonstrates that our collaborative efforts to prevent, identify and prosecute the most egregious instances of health care fraud have never been stronger," Attorney General Eric Holder said. "Over the years, we've seen that as these crimes harm all of us — government agencies and programs, insurers and health care providers, and individual patients."

Officials attributed much of the progress to nine patrol teams that moved into cities, such as Chicago and Miami, to investigate crime trends. The government increased funding to Senior Medicare Patrol teams from $9 million in 2010 to $18 million in 2011 in the form of Administration on Aging grants in fraud-rich states, such as California and Michigan. The 2010 federal health care law also increased funding to fraud-fighting efforts by $350 million.

The Health Care Fraud Prevention and Enforcement Action Teams, known as HEAT, sent 175 people to prison, where the average sentence was 47 months, according to the Justice Department.

The teams were created in 2009.

"I expect that we will be expanding those efforts to additional cities," said Peter Budetti, director for the Centers for Medicare and Medicaid Services' Center for Program Integrity.

HHS Secretary Kathleen Sebelius said her budget would include $300 million to pay for new anti-fraud teams. The locations of the new teams would be secret, Sebelius said, and determined by trends spotted by analyzing various department data.

In 2011, civil health care fraud cases brought in $2.4 billion under the False Claims Act, while the Justice Department filed criminal charges against 1,430 people for health care fraud — the most ever in a single year.