Federal Healthcare Fraud Enforcement Efforts Yield a 790% Return


Last week, the U.S. Department of Health and Human Services (HHS) and the DOJ jointly released a report concluding that, for every dollar spent on healthcare fraud investigations in the last three years, the government recovered $7.90 through enforcement, averaging the highest return on investment in the 16-year history of the Healthcare Fraud and Abuse Control Program (HCFAC). The HCFAC Annual Report (Annual Report) also stated that the government recovered more than $4.2 billion in FY 2012.

By way of background, HCFAC is operated by the DOJ and HHS to coordinate law enforcement activities related to healthcare fraud and abuse. HCFAC issues an Annual Report detailing the amounts deposited into the U.S. Treasury or directly into the accounts of other federal agencies as a result of healthcare fraud enforcement efforts.

Notably, the above figures underscore that government efforts to deter healthcare fraud continue even after the conclusion of an enforcement action. For example, of the $4.2 billion recovered, more than one-third was collected through court-ordered criminal fines and restitution. While the Annual Report does not provide specifics of such instances, the court and government often must take affirmative action to collect criminal fines and restitution imposed by the court at the conclusion of a case. In addition, the Annual Report states that $20 million was returned to the U.S. Treasury as a result of asset forfeiture proceedings, which may similarly be brought following the conclusion of an enforcement matter.

The Annual Report likely will provide further mandate for ongoing enforcement activity that we've seen over the last several years. BakerHostetler continues to encourage our clients to maintain active compliance programs to avoid becoming a statistic.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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