Health Care Fraud & Abuse Control Report for Fiscal Year 2012

The Fiscal Year 2012 Health Care Fraud and Abuse Control (HCFAC) Program Report to Congress was recently published. To view the full 99-page report click here.

The national Health Care Fraud and Abuse Control Program (HCFAC) was established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Program is carried out jointly at the direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), acting through the Inspector General. The Program aims to coordinate federal, state and local law enforcement activities with respect to health care fraud and abuse.

To read the Department of Health and Human Services press release about the report click here.

Highlights from the Report include:

  • During FY 2012, the Federal government won or negotiated over $3.0 billion in health care fraud judgments and settlements (the amount reported as won or negotiated only reflects Federal recoveries and therefore does not reflect state Medicaid monies recovered as part of any global, Federal-State settlements).
  • In FY 2012, approximately $4.2 billion was deposited with the Department of the Treasury and the Centers for Medicare & Medicaid Services (CMS); transferred to other federal agencies administering health care programs; or paid to private persons during the fiscal year.
  • Of the $4.2 billion, the Medicare Trust Funds received transfers of approximately $2.4 billion, and over $835.7 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts.
  • The HCFAC account has returned over $23.0 billion to the Medicare Trust Funds since the inception of the Program in 1997.
  • In FY 2012 the Department of Justice (DOJ) opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants.
  • Federal prosecutors had 2,032 health care fraud criminal investigations pending, involving 3,410 potential defendants, and filed criminal charges in 452 cases involving 892 defendants.
  • A total of 826 defendants were convicted of health care fraud-related crimes during the year.
  • The DOJ opened 885 new civil health care fraud investigations and had 1,023 civil health care fraud matters pending at the end of the fiscal year.
  • In FY 2012, Federal Bureau of Investigation (FBI) health care fraud investigations resulted in the operational disruption of 329 criminal fraud organizations, and the dismantlement of the criminal hierarchy of more than 83 criminal enterprises engaged in health care fraud.
  • In FY 2012, HHS-Office of Inspector General (HHS-OIG) excluded 3,131 individuals and entities. Among these were exclusions based on criminal convictions for crimes related to Medicare and Medicaid (912) or to other health care programs (287); for patient abuse or neglect (212); and as a result of licensure revocations (1,463).
  • HHS-OIG imposed civil monetary penalties against, among others, providers and suppliers who knowingly submitted false claims to the Federal government.
  • HHS-OIG also issued numerous audits and evaluations with recommendations that, when implemented, would correct program vulnerabilities and save program funds.

The HHS-OIG recently updated its List of Excluded Individuals/Entities (LEIE) database with January 2013 Exclusions and Reinstatements. The database provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs. Click here for more information.