Feds recover $2.4 billion from health care fraudNews added by Benefits Pro on March 3, 2016

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By Jack Craver

The U.S. government is happy to let you know that it recovered $2.4 billion in 2015 from health care fraudsters.

Granted, it doesn't make up for the amount the U.S. spends a year on unused cancer medication, but it’s a pretty penny nonetheless.

“Since its inception in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has returned more than $29.4 billion to the Medicare Trust Funds,” said the Department of Justice in a statement. “In this past fiscal year, the HCFAC program has returned $6.10 for each dollar invested.”

A key component of the program is the Medicare Fraud Strike Force, which goes after criminal enterprises that pose as health care providers or suppliers, the agency said. In the past eight years, the taskforce has prosecuted over 2,500 people for health care fraud totaling over $8 billion.

The lion's share of the money recovered by the DOJ last year came from civil actions taken against individuals or entities the department accused of defrauding Medicaid, Medicare or other federal health programs with false claims. The feds got $1.9 million out of settlements and judgments related to such cases in 2015.

The department, no doubt sending a warning to would-be fraudsters, touted the way in which new technology has made detecting fraud easier. Software equipped with algorithms that identify claims trends for “known fraud patterns” allows investigators to quickly zero in on likely abuse.

In addition, the Patient Protection and Affordable Care Act (PPACA) put in place new safeguards to ensure that the 1.6 million Medicare providers and suppliers are legitimate. The Centers for Medicare and Medicaid Services halted the enrollment in Medicare of roughly half a million would-be suppliers and providers, insisting that they submit more information.

“CMS also revoked more than 34,000 enrollments meaning, these providers were barred from re-entering the Medicare program for one to three years,” said the statement. “These enhanced screening and enrollment requirements have led to more than $2.4 billion in estimated Medicare savings since 2010.”

Originally posted on BenefitsPro.com
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