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$4.1 billion Recovered from Healthcare Fraud in 2011

On Monday government officials announced the largest recovery of fraudulent healthcare payments on record was secured in fiscal 2011, amounting to $4.1...

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|Feb 13|magazine5 min read

On Monday government officials announced the largest recovery of fraudulent healthcare payments on record was secured in fiscal 2011, amounting to $4.1 billion. Backing the sum is the largest number of defendants to be charged in a year for healthcare fraud-related crimes: 1,430.

The Justice Department and Department of Health and Human Services (HHS) reported a 50% percent increase in reclaimed funds was observed from 2009 to 2011, comprised of settlements related to fraudulently-obtained Medicare and Medicaid. Of the 1,430 charged, 734 defendants were convicted during the year.

The striking increase has been credited to the Medicare Fraud Strike Force teams and the Health Care Fraud Prevention & Enforcement Team (HEAT). HEAT is a task force that was created in 2009 to address healthcare fraud.

"Our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off: We are gaining the upper hand in our fight against healthcare fraud," Health and Human Services Secretary Kathleen Sebelius said in a released statement. 

Data analysis was used to help the teams identify high billing levels in known healthcare “fraud hot spots.” Detroit and Miami joined the list, bringing the total to nine. Other cities that made the list include Los Angeles, Brooklyn, Houston, Tampa and Baton Rouge.

Nearly 10% of all received Medicare payments fund fraudulent claims, a 2011 government report found.

"Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars," said Sebelius. "Our efforts strengthen the integrity of our healthcare programs and meet the president's call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules."