Highest Recovery Results Yet in Medicare Fraud Prevention Efforts for 2012

Highest Recovery Results Yet in Medicare Fraud Prevention Efforts for 2012

Multiple level, inter-agency and grassroots efforts to combat fraud are paying off, as confirmed in the U.S. Department of Health and Human Services’ (HHS) recent announcement of record breaking recovery results for 2012. Our own Senior Medicare Patrol (SMP) team has directly contributed to this success in recovering over $1.6 million to Medicare in 2012, among other successes. These local efforts, combined with the increased coordination and partnerships among the Justice Department, HHS, the Federal Bureau of Investigation (FBI), local law enforcement agencies and community organizations and the expansion of the Medicare Fraud Strike Force teams are making a huge difference in eliminating fraud.

Some of the highlights in HHS’ press release include:

  • For every $1 invested in health care fraud investigations, the government recovered $7.60. This is the highest amount recovered in the 16 years of actively combating fraud.
  • Health care fraud and prevention efforts recovered a record $4.2 billion in taxpayer dollars in 2012.
  • In the past 4 years, the government’s investigation and enforcement efforts have recovered $14.9 billion, up from $6.7 billion during the previous 4-year period.
  • As a result using the new Automated Provider screening system that quickly identifies ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation, nearly 150,000 ineligible providers have already been eliminated from Medicare’s billing system.
  • Between May 2011 and May 2012, 150,000 providers lost the ability to bill Medicare due to ACA requirements and other initiatives.

Also, according to the press release, the Medicare strike force coordinated a takedown with the largest number of fraudulent Medicare billings in the history of the strike force teams.  The takedown involved 107 people in 7 cities, including doctors and nurses who were charged for their alleged participation in these Medicare fraud scams, involving about $452 million in false billings.

Much of this success is directly related to the Obama Administration’s commitment to eliminate fraud, waste and abuse. Also, the Affordable Care Act provides multiple new tools for combating and preventing fraud, including “enhanced screenings and enrollment requirements, increased data sharing across the government, expanded recovery efforts for overpayments and greater oversight of private insurance abuses.”

For more information, see the Health Care Fraud and Abuse (HCFAC) Program report. Also see the U.S. Department of Health and Human Services’ press release.


Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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