2009 Health Care Fraud Report Released

Today, Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced the results of the 2009 Health Care Fraud and Abuse Control Program Annual Report (HCFAC), which outlines the last fiscal year’s health care fraud prevention and enforcement achievements. This report shows the success of DOJ and HHS’ collaborative efforts to prevent, identify, and prosecute the most egregious instances of health care fraud.  In fact, last year brought record levels of achievement. 

• Approximately $2.5 billion was deposited in FY09 to the Medicare Trust Fund – an increase of more than half a billion dollars over the prior year’s total. 
• $1.6 billion in judgments and settlements were won or negotiated. 
• The Justice Department’s Criminal Division, in cooperation with U.S. Attorneys’ Offices around the country, opened more than 1,000 new criminal health care fraud investigations and had more than 1,600 health care fraud criminal investigations pending. 
• The department indicted an “all-time high” number of health care fraud defendants  -- more than 800 -- in nearly 500 cases filed and obtained close to 600 convictions.  The Justice Department’s Civil Division opened nearly 900 new civil health care fraud investigations and had more than 1,100 pending cases

Last year also brought a critical step forward in the fight against health care fraud with the creation of the Health Care Fraud Prevention & Enforcement Action Team, or HEAT.   By making the fight against both civil and criminal health care fraud a Cabinet-level priority, DOJ and HHS are bringing to bear the full resources of the federal government against individuals and corporations who illegally divert taxpayer resources for their own gain. Through the HEAT initiative, the departments expanded Medicare Fraud Strike Forces. To date:

• Strike Force prosecutors have sought approximately $500 million in court-ordered restitution to the Medicare program in nearly 300 health care fraud cases involving more than 560 defendants. 
• More than 300 guilty pleas have been secured, and 250 defendants have been sentenced to prison – with sentences ranging from two months to 30 years. 
• On the civil enforcement front, health care fraud recoveries last year under the False Claims Act exceeded a $2.2 billion dollars. 

Looking forward, the departments will fully utilize expanded capabilities, including tough new rules and penalties, which the Affordable Care Act provides to stop health care fraud in its tracks, working with our federal, state, local and tribal law enforcement partners.

Read the full 2009 HCFAC report. To learn more about HEAT, go to: www.stopmedicarefraud.gov.