More Than $4 Billion In Health Care Fraud Recovered

By: USDOJ Press Release
By: USDOJ Press Release

Washington, D.C. -- February 14, 2012 --

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new
report showing that the government's health care fraud prevention and
enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in
Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.

These findings, released today, in the annual Health Care Fraud and
Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.

"This report reflects unprecedented successes by the Departments of
Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs," said Attorney General Holder. "We can all be proud of what's been achieved in the last fiscal year by the Department's prosecutors, analysts and investigators - and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight."

"Fighting fraud is one of our top priorities and we have recovered an
unprecedented number of taxpayer dollars," said Secretary Sebelius.
"Our efforts strengthen the integrity of our health care programs, and
meet the President's call for a return to American values that ensure
everyone gets a fair shot, everyone does their fair share, and everyone
plays by the same rules."

Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an
unprecedented achievement for HCFAC, a joint effort of the two
departments to coordinate federal, state and local law enforcement
activities to fight health care fraud and abuse.

The recently-enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts,
including an additional $350 million for HCFAC activities. The
administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.

Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.

In FY 2011, the total number of cities with strike force prosecution
teams was increased to nine, all of which have teams of investigators
and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.

Including strike force matters, federal prosecutors filed criminal
charges against a total of 1,430 defendants for health care fraud
related crimes. This is the highest number of health care fraud
defendants charged in a single year in the department's history.
Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.

In criminal matters involving the pharmaceutical and device
manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.

The departments also continued their successes in civil health care
fraud enforcement during FY 2011. Approximately $2.4 billion was
recovered through civil health care fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by
pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.

The fraud prevention and enforcement report announced today coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face an explicit deadline for returning taxpayers' money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be reported and returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements today are just the latest in a series of steps
that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.

The HCFAC annual report can be found here, For more information on the joint
DOJ-HHS Strike Force activities, visit:

For more information on the fraud prevention accomplishments under the Affordable Care Act visit: .

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  • by Georgia Boy Location: Cairo on Feb 19, 2012 at 07:58 AM
    Does "single payer system" mean government operated? If so, think twice. Consider the track record of ANYTHING government operated.
  • by Dr. Doctor on Feb 15, 2012 at 06:34 AM
    They need to tackle the biggest fraud of all - "health insurance". The greedy criminals that run this "industry" are nothing more than mafioso. We need a single payer system in this country that eliminates the middle man crooks that are bleeding this country dry.
  • by t bob on Feb 15, 2012 at 06:22 AM
    just think they laude this but fail to mention that our own governor's company paid a penalty of nearly half this amount (1.7 billion). how is he not a crook???
  • by Anonymous on Feb 15, 2012 at 05:06 AM
    Good, now this 4billion needs to go back the the Medicare fund so those conservatives who want to eliminate the program can see its got more operating revenue and they don`t have to tax their top 10%. Also this should be lowering medical insurance premiums if those who commit the fraud have been stopped from the practice, doubt my premiums will go back down so there is another fraud against policyholders by the insurers.
    • reply
      by Anonymous on Feb 15, 2012 at 12:19 PM in reply to
      ..."so those conservatives who want to eliminate the program "... Every year the Pulitzer Prize-winning website picks the biggest political lie of the year. In 2011, the democrats won with their claim that republicans wanted to end medicare. Here's a brief quote from their site. "This was a claim we heard over and over again after the House voted in April on a budget by (Rep. Paul Ryan (R, Wis.). It's just not true," Adair said. "The way they say it, they say the House voted to end Medicare. That's not what they did. The House voted to protect Medicare on people who are 55 or older, but to privatize it and restructure it in a dramatic way for people who are younger. It's wrong to say 'end Medicare' and it's the classic scare tactic we've seen targeting the elderly for many years." Of course, facts have never gotten in the way of the media's political bias.
  • by If the glove don't fit, regulate on Feb 14, 2012 at 05:36 PM
    That's why we need good oversight and regulations to STOP crooks from stealing.
  • by Dale on Feb 14, 2012 at 04:17 PM
    Did the Governor give back what he stole?
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