Government says it recovers billions in health fraud crackdown


WASHINGTON — The federal government recovered a record $4.2 billion in the last fiscal year from medical providers and others who fraudulently billed government healthcare programs such as Medicare, the Obama administration announced Monday.

The 2012 tally — which surpassed the $4.1 billion the government reclaimed the previous fiscal year — extends a years-long trend and reflects efforts by the Obama administration to crack down on healthcare fraud.

The president’s healthcare law includes new initiatives to weed out fraudulent medical providers and bar them from receiving Medicare reimbursements.


“Our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off: We are gaining the upper hand,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

Over the last four years, enforcement efforts have yielded $14.9 billion, up from $6.7 billion over the previous four years, the administration said.

The Justice Department, which is working closely with the health agency to reduce fraud, also reported that 826 people were convicted of crimes related to healthcare fraud last year, another record.

Despite the stepped-up enforcement, independent analyses continue to find holes in the federal government’s anti-fraud efforts.

Last month, the Health and Human Services Department’s inspector general reported that an initiative designed to identify waste and abuse in Medicare’s drug benefit program and Medicare Advantage had managed to find just a handful of cases. About a quarter of Medicare beneficiaries receive their benefits through Medicare Advantage, which allows private insurance companies to contract with the government to administer benefits.

That report drew stern criticism from members of Congress from both parties. “This lack of progress is deeply disappointing,” said Sen. Thomas R. Carper (D-Del.).


There is broad agreement that fraud is widespread in Medicare and Medicaid, but estimates of the scope vary from $20 billion a year to more than $100 billion. Total spending on the two mammoth entitlement programs is expected to surpass $1 trillion this year.