U.S. recovers $4.2 bln from healthcare fraud probes in 2012

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 U.S. 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.

Healthcare lawyers representing both providers and whistle-blowers said the announcements echoed patterns they have observed in their practices and that the trend toward more rigorous enforcement has boosted business.

"We're doing more and more fraud and abuse work, and we also work with providers like hospitals and doctors' offices who are more concerned about compliance issues," said Robert Brennan, a former prosecutor who now represents healthcare companies as a partner in Parker Hudson Rainer and Dobbs in Atlanta. "(Companies are) scared because if the government comes knocking, it can mean big trouble for their business."

Lesley Ann Skillen, a partner in the New York firm Getnick and Getnick, who has represented whistle-blowers in fraud cases since the 1990s, said that the Justice Department has been increasingly eager to work with firms such as hers.

"We bring them good cases, and success breeds more success," she 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 previous four-year period.

source