HHS and DOJ Release Annual Report on Health Care Fraud and Abuse Control Program, Which Recovered $4.2 Billion in FY 2012


On February 13, 2013, the U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) released their annual report for fiscal year 2012 on the Health Care Fraud and Abuse Control Program (HCFAC).  The report summarizes the federal government’s monetary recoveries and enforcement actions with respect to federal healthcare programs during the past year.

According to the report, the government recovered approximately $4.2 billion from its healthcare fraud prevention and enforcement efforts in 2012, which constitutes the highest amount recovered since the inception of HCFAC.  This sum includes more than $3 billion in healthcare fraud judgments and settlements as well as other administrative recoveries in healthcare fraud cases and proceedings.  The report also notes that the government recovered nearly eight dollars for every dollar spent on healthcare-related fraud and abuse investigations in the last three years.

Of the $4.2 billion recovered, more than $2.4 billion was transferred to the Medicare Trust Funds, nearly $1.5 billion was deposited with other federal agencies, and close to $285 million was paid to qui tam relators in False Claims Act cases.

In terms of criminal enforcement actions, DOJ opened more than 1,130 new criminal healthcare fraud investigations, which involved nearly 2,150 potential defendants.  In addition, there were more than 2,030 healthcare fraud criminal investigations pending, and a total of 826 defendants were convicted of healthcare fraud-related crimes, in 2012.  DOJ also opened 885 new civil investigations and had more than 1,020 civil healthcare fraud matters pending.

The report also addresses other enforcement efforts that were undertaken by the federal government in 2012 to prevent and combat fraud and abuse.  In the DOJ press release, available here, Attorney General Eric Holder said, “In the past fiscal year, our relentless pursuit of health care fraud resulted in the disruption of an array of sophisticated fraud schemes and the recovery of more taxpayer dollars than ever before.  This report demonstrates our serious commitment to prosecuting health care fraud and safeguarding our world-class health care programs from abuse.”

The HCFAC report is available here.

Reporter, Jennifer S. Lewin, Atlanta, +1 404 572 3569, jlewin@kslaw.com.

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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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