Health Care Fraud Summary 2012

The annual report of The Department of Justice Health Care Fraud and Abuse Control Program was issued in February 2013. The executive summary included the following statistics:

    Monetary Results

    During Fiscal Year (FY) 2012, the Federal government won or negotiated over $3.0 billion in health care fraud judgments and settlements, and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, 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 this $4.2 billion, the Medicare Trust Funds received transfers of approximately $2.4 billion during this period, 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.

    Enforcement Actions

    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. Also in FY 2012, 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). In addition, HHS/OIG imposed civil monetary penalties against, among others, providers and suppliers who knowingly submittedfalse 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.