Health Care Fraud Prevention and Enforcement Results in $4.1 Billion Recovery

The Department of Justice and the Department of Health and Human Services released the Health Care Fraud and Abuse Control Program annual report, which reported that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion of taxpayer money for the fiscal year 2011. According to a press release, this is the highest annual amount ever recovered.

The recovery is the result of increased efforts to prevent fraud, waste and abuse in Medicare and Medicaid programs, a top priority of President Obama’s administration. In 2009, the Health Care Fraud Prevention and Enforcement Action Team was created, and its efforts were further enhanced with the recently-enacted Affordable Care Act. An additional $350 million was provided for HCFAC activities, and the government also increased the number of Medicare Fraud Strike Force teams.

“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” Attorney General Eric Holder stated in the release. “We can all be proud of what’s been achieved in the last fiscal year by the [Justice] Department’s prosecutors, analysts and investigators and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”

The release of the HCFAC report coincides with the announcement of a proposed rule from the Centers for Medicare & Medicaid Services aimed at recollecting overpayments in the Medicare program more quickly. Before the Affordable Care Act, there was no specific deadline for providers to return overpayments to CMS. Under the new legislation, providers will have 60 days to return any overpayment. Failure to return overpayments within the specified timeframe could result in a violation of the False Claims Act, civil monetary penalties or exclusion from federal health care programs.

“It is crucial that we are wise stewards of taxpayers’ dollars,” Marilyn Tavenner, acting administrator of CMS, stated in a press release. “Thanks to the Affordable Care Act, we have new authority to help protect and preserve the Medicare Trust Funds.”

To read the full HCFAC report, visit

For more information about the proposed CMS rule, visit

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