Technology helps government recoup $4B in Medicare, Medicaid fraud

By Stephanie Bouchard
10:07 AM

The efforts to curtail healthcare fraud have returned $4.1 billion to U.S. taxpayers in 2011, accordingi to a new report from the U.S. Department of Health and Human Services and the Department of Justice. The fraud-fighting techniques employed by the government are largely supported by new information technology.

“Today’s report also shows that going after healthcare fraud continues to be one of the best investments we can make as a country. Over the last three years, for every dollar we’ve spent, we’ve put more than $7 back in the hands of American taxpayers,” said Kathleen Sebelius, HHS’ secretary, during a live web broadcast Tuesday announcing the report’s findings.

According to the report, as a result of the efforts of the DOJ’s and HHS’ Health Care Fraud and Abuse Control Program (HCFAC) approximately $2.4 billion in healthcare fraud judgments and settlements were won or negotiated in 2011. Of the $4.1 billion returned to U.S. taxpayers, approximately $2.5 billion was returned to the Medicare Trust Funds and more than $599.9 million in federal Medicaid money was transferred to the U.S. Treasury.

“Despite these remarkable successes, we understand that we cannot rest. Instead we must take our work to the next level,” said Eric Holder, the attorney general, during the webcast. Holder said the DOJ and HHS would expand their antifraud strategies and techniques, which may mean the two agencies will increase the number of its Medicare Strike Force teams and the number of hot spot cities – locations deemed to be high-claims areas – the teams monitor.

In its fiscal year 2013 budget, HHS proposes to continue making progress against healthcare fraud by increasing support through mandatory and discretionary funding. For FY 2013, the mandatory funding level is $1.3 billion. HHS is requesting $610 million in discretionary funds. In its FY 2013 budget request, the DOJ asked for $294.5 million in mandatory and discretionary funding to fight healthcare fraud.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.