In a report released on March 19th, the federal government stated that its Heath Care Fraud and Abuse Control Program (HCFAC) recovered $3.3 billion during FY 2014, including $2.3 billion in healthcare fraud judgments and settlements. The HCFAC reported its return on investment (ROI) to be $7.7 returned for every $1 expended over the last three years (2012-2014). According to the Report, this is $2 higher than the average ROI for the life of the HCFAC program since 1997 and the third highest ROI overall.
The government provided these figures as a part of an annual report to Congress from the Department of Justice (DOJ) and the Department of Health and Human Services (HHS).
Of the $3.3 billion recovered, the Medicare Trust Funds received transfers of approximately $1.9 billion, and another $523 million in Federal Medicaid money was transferred to the Treasury separately as a result of these efforts. According to the Report, the HCFAC account has returned over $27.8 billion to the Medicare Trust Funds since the inception of the Program in 1997.
The total overall amount HCFAC recovered in FY 2014 is down $1 billion from FY2013. Its recovery from healthcare fraud judgments and settlements is also down $300 million from FY2013, which had seen the largest annual amount collected since the Health Insurance Portability and Accountability Act of 1996 provided funding for the program.
The Report noted that, due to sequestration of mandatory funding in 2014, there were fewer resources for DOJ, FBI, HHS, and HHS-OIG to fight fraud and abuses against Medicare, Medicaid, and other healthcare programs. Nevertheless, in FY 2014, the DOJ opened 924 new healthcare fraud criminal investigations (down from 1,013 in FY2013) and 782 new civil healthcare fraud investigations (down from 1,083 in FY2013).
Similarly, HHS’ Office of Inspector General (OIG) brought 867 criminal actions against persons engaged in Medicare or Medicaid related crimes (up from 849 in FY2013) and 529 civil actions (up from 458 in FY2013).