For Every $1 Spent on Fraud Investigation $7.90 Recovered
Monday, February 25, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

The Department of Justice and the Department of Health and Human Services (HHS) released a new report showing that for every dollar spent on health care-related fraud and abuse investigations by the Health Care Fraud and Abuse (HCFAC) Program over the last three years, the government recovered $7.90. This is the highest three-year average return on investment in the 16-year history of the program.

About $4.2 billion stolen or otherwise fraudulently obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and other departments in FY 2012. This is an increase from nearly $4.1 billion recovered in FY 2011. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds. This joint effort was made possible by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009. 

The Department of Justice and HHS also continued their successes in civil health care fraud enforcement during FY 2012. The Justice Department’s Civil Division Fraud Section, obtained more than $3 billion in settlements and judgments on FY 2012 under the False Claims Act (FCA). This marked the third year in a row that more than $2 billion has been recovered in FCA health care matters.

In 2012, the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants. Of those defendants, 826 were convicted of health care fraud-related crimes. The department also opened 885 new civil investigations.

In 2012, CMS began the process of screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system that identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation. As a result, nearly 150,000 lost the ability to bill the Medicare program.

The HCFAC annual report is available at on the HHS Office of Inspector General Website here.  For more information on the joint DOJ-HHS Strike Force activities, visit
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