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Feds brokered record $5B in healthcare fraud cases last year


bpperry via Getty Images Dive Brief:

The federal government won or negotiated more than $5 billion in healthcare fraud judgments and settlements in its 2021 fiscal year, the largest amount ever in the history of the HHS and Department of Justice’s fraud and abuse enforcement program.

Due to those and other efforts from previous years, the government clawed back almost $1.9 billion, according to a new report from the departments.

Of that $1.9 billion, about $1.2 billion went to the Medicare trust funds, which are on increasingly precarious financial footing due to growing stress on the insurance program. In addition, roughly $99 million in federal Medicaid money was transferred back to the CMS.

Dive Insight:

Around 25 years ago, the HIPAA privacy law established the Health Care Fraud and Abuse Control Program, bringing together the DOJ and the HHS to coordinate law enforcement actions related to healthcare fraud and abuse, a perennial problem in the U.S.Bad actors see significant opportunities for profit in the $4 trillion industry. Now, that fraud has been exacerbated by the pandemic as the COVID-19 public health response caused billions in new federal dollars to flow to healthcare companies with little oversight.Over the past decade, […]

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