HHS and DOJ Release the Health Care Fraud and Abuse Program Report

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released the Health Care Fraud and Abuse (HCFAC) Program Report. The HCFAC report revealed “record breaking” recoveries, such as a $7.90 return for every dollar spent on health care fraud and abuse investigations over the past 3 years. Further, the government has recovered over $23 billion during the past 16 years.

Notably, the HHS and Centers for Medicare & Medicaid Services (CMS) have taken steps to reduce health care fraud and abuse, including:

• Implementing a new Automated Provider Screening system;
• Expanding data sharing across government;
• Advancing data analysis methods; and
• Increasing recovery efforts for overpayments.

The new Automated Provider Screening system identifies ineligible and fraudulent providers and suppliers prior to enrollment or revalidation. Currently, CMS has screened over 400,000 providers using the system, and removed 150,000 ineligible providers from Medicare’s billing system.

The HHS and DOJ HCFAC program report is available at: https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2012.pdf.

The HHS news release on the HCFAC program report is available at: http://www.hhs.gov/news/press/2013pres/02/20130211a.html.

The DOJ press release on the HCFAC program report is available at: http://www.justice.gov/opa/pr/2013/February/13-ag-180.html.

Department of Health and Human Services. “Departments of Justice and Health and Human Services announce record-breaking recoveries resulting from joint efforts to combat health care fraud.” News Release. 11 Feb. 2013.

Department of Health and Human Services Office of Inspector General. “The Department of Health and Human Services and The Department of Justice Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2012.” Feb. 2013.