Los Feds tout el expediente recuperación del fraude del cuidado médico $4 mil millones

por Brendon Nafziger, DOTmed News Associate Editor | January 24, 2011
Federal officials have recovered more than $4 billion in taxpayer money from health care fraud last fiscal year, the most ever recouped in a single year.

On Monday, the U.S. Department of Health and Human Services and the Justice Department touted what they said was a record year for busting Medicare, Medicaid and drug fraud, with the agencies netting about $2.5 billion in court judgments or settlements.

An additional $1.5 billion came from administrative impositions, the HHS said in its report.

Officials also announced new tools from the Affordable Care Act that they say will make it easier to prevent fraud. These include a tougher screening process for those deemed a "higher risk" for fraud, such as durable medical equipment suppliers, and the ability to suspend payments in light of credible fraud allegations.

"Thanks to the new law, CMS now has additional resources to help detect fraud and stop criminals from getting into the system in the first place," said Centers for Medicare and Medicaid Services chief Dr. Donald Berwick, in a statement.

Nearly half of the recovered money involved drug companies. Allergan Inc. had to cough up $600 million to resolve a suit that they illegally promoted off-label uses of Botox. AstraZeneca Pharmaceuticals and Novartis Pharmaceuticals also reached agreements worth nearly $1 billion arising from separate claims that they promoted off-label uses of their drugs.

Other cases involved a netherworld of kickback schemes, forged Medicare claims and dubious clinics or equipment suppliers.

Whistle-blowers were instrumental in bringing the fraud to light, federal officials said, pocketing about $300 million last year as part of actions brought about from their alerts, according to USA Today.

The Justice Department said it opened more than 1,000 criminal health care fraud investigations last year against over 2,000 possible defendants. More than 700 defendants were convicted of health care fraud-related crimes, the DOJ said.

The report said the return-on-investment for the DOJ and HHS' 14-year-old fraud-fighting program was $4.9 recouped for every $1 spent on enforcement.

The agency also credited the Medicare Fraud Strike Force with bringing about numerous indictments in the seven cities it's active in. The group was launched about four years ago during a crackdown on fraud in Miami and southern Florida, a hotbed for Medicare scams.