Precipitous Increase in Fraud And Abuse Recoveries To Medicare Trust Fund

As reported in the May 14th HLP blog, the Departments of Justice (DOJ) and Health and Human Services (HHS) recently released the Health Care Fraud and Abuse Control Program (HCFAC) Annual Report for Fiscal Year 2009, which reflects that $2.51 billion was deposited to the Medicare Trust Fund in 2009, as a result of more intensive efforts to fight fraud and abuse. U.S. Attorney General Eric Holder announced that the 2009 recovery amount represented an increase of more than half a billion dollars over the 2008 total. Evidencing the heightened scrutiny that we, at THE HEALTH LAW PARTNERS, have been discussing with our clients during this past year, more than 1,000 new criminal health care fraud investigations were opened in 2009, 1,621 investigations were pending, and 583 convictions for health care fraud-related crimes were obtained. In addition, federal prosecutors filed criminal charges in 481 cases involving 803 defendants which, according to Holder, constitutes an “all-time high” in the number of health care fraud defendants charged. In addition, DOJ opened 886 new civil health care fraud investigations and had 1,155 civil health care fraud matters pending. Holder also noted that, in 2009, the DOJ and HHS established the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which has operated with noteworthy efficacy in, among other places, two of the States with HLP offices – New York (Brooklyn) and Michigan (Detroit). In sum, the Annual Report speaks to the successes that the Government’s deployment of additional resources has enabled it to achieve in connection with its goal of reducing health care fraud – and this success likely presages the Government dedicating even-greater resources towards health care enforcement in the coming years.

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