Fraud and Abuse Judgments and Settlements Recoup $1.5 Billion for Medicare

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Written by Rob Kurtz

Thursday, 21 February 2008

The Health Care Fraud and Abuse Control Program (HCFAC) recovered approximately $1.5 billion in 2006 as a result of fraud and abuse judgments and settlements, according to a report from the Department of Health and Human Services and the Department of Justice.

The efforts of the program also yielded $177.1 million in Medicaid money. HCFAC has returned more than $10.4 billion to Medicare since the program's inception in 1997.

In 2006, 547 defendants were convicted for healthcare fraud-related crimes. U.S. attorneys' offices opened 836 new criminal healthcare fraud investigations in 2006, involving 1,445 potential defendants. The DOJ initiated 915 new civil health care fraud investigations in 2006.

Perhaps the notable accomplishment of HCFAC's efforts in 2006 was Tenet Healthcare Corporation's agreeing to pay more than $900 million over a four-year period to settle whistleblower lawsuits accusing Tenet of overbilling Medicare and other federal healthcare programs.

Of the $900 million, "more than $788 million to resolve claims arising from Tenet's receipt of excessive 'outlier' payments (payments intended to be limited to situations involving extraordinarily costly episodes of care) resulting from the hospitals' inflating their charges substantially in excess of any increase in the costs associated with patient care, and billing for services and supplies not provided to patients," according to the report.

Read the complete report here.