For the fifth year in a row, federal fraud prevention efforts have seen an increase in the amount of money which has been recovered from individuals and companies who attempted to defraud federal health programs serving seniors or who sought to obtain payments to which they were not entitled. A record $4.3 billion dollars was recovered this past fiscal year. This was an increase from the $4.2 billion which obtained in fiscal year 2012. Over the last five years, a total of $19.2 billion has been returned to the taxpayers, more than double the $9.4 billion which was received in the prior five year period.
In addition to monetary recoveries, investigations have led to significant prison sentences for those who have been convicted of engaging in unlawful activity. In fiscal year 2013, the average prison term was 52 months.
An annual report issued by the Health Care Fraud and Abuse Control Program showed that the government recovers $8.10 for every dollar spent on health-care related fraud and abuse investigations.
A key player in uncovering fraudulent activity is the Health Care Fraud Prevention and Enforcement Team (“HEAT”). This organization was created in 2009 and focuses on preventing fraud, waste and abuse in the Medicare and Medicaid programs. It has also allowed the Justice Department and Department of Health and Human Services to improve their coordination. HEAT is now operating Medicare Fraud Strike force teams in fraud hot spots throughout the country. Advanced data analysis techniques are used to identify high-billing levels and allow investigators to target emerging schemes, schemes which are shifting locations and chronic fraud by those who are pretending to be healthcare providers or suppliers.