Fiscal Year 2013 HCFAC Report Issued

Today, the Fiscal Year 2013 Health Care Fraud and Abuse Control (HCFAC) Program Report to Congress was published. To view the full 105-page report click here.

A national Health Care Fraud and Abuse Control Program (HCFAC) was established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Program is carried out jointly at the direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), acting through the Inspector General. The Program aims to coordinate federal, state and local law enforcement activities with respect to health care fraud and abuse.

To read the Department of Health and Human Services press release about the report click here.

Highlights from the Report include:

  • During FY 2013, the Federal government won or negotiated over $2.6 billion in health care fraud judgments and settlements (the amount reported as won or negotiated only reflects Federal recoveries and therefore does not reflect state Medicaid monies recovered as part of any global, Federal-State settlements).
  • In FY 2013, approximately $4.3 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 the $4.3 billion, the Medicare Trust Funds received transfers of approximately $2.85 billion, and over $576 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts.
  • The HCFAC account has returned over $25.9 billion to the Medicare Trust Funds since the inception of the Program in 1997.
  • In FY 2013 the Department of Justice (DOJ) opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants.
  • Federal prosecutors had 2,041 health care fraud criminal investigations pending, involving 3,535 potential defendants, and filed criminal charges in 480 cases involving 843 defendants.
  • A total of 718 defendants were convicted of health care fraud-related crimes during the year.
  • The DOJ opened 1,083 new civil health care fraud investigations and had 1,079 civil health care fraud matters pending at the end of the fiscal year.
  • In FY 2013, Federal Bureau of Investigation (FBI) health care fraud investigations resulted in the operational disruption of 425 criminal fraud organizations, and the dismantlement of the criminal hierarchy of more than 115 criminal enterprises engaged in health care fraud.
  • In FY 2013, HHS-Office of Inspector General (HHS-OIG) excluded 3,214 individuals and entities. Among these were exclusions based on criminal convictions for crimes related to Medicare and Medicaid (1,132) or to other health care programs (311); for patient abuse or neglect (180); and as a result of licensure revocations (1,324).
  • In FY 2013, HHS-OIG investigations resulted in 849 criminal actions against individuals and entities that engaged in crimes related to Medicare and Medicaid and 458 civil actions.
  • HHS-OIG also issued numerous audits and evaluations with recommendations that, when implemented, would correct program vulnerabilities and save program funds.
  • The report notes that due to Sequestration there were fewer resources for DOJ and HHS to fight fraud and abuse against Medicare, Medicaid and other healthcare programs. A total of $30.6 million was sequestered from the HCFAC program in FY 2013.