By Susan Kelly
Feb 11 (Reuters) - The Obama administration said on Monday
that its efforts to combat fraud in the Medicare and Medicaid
healthcare programs were paying off as the government recovered
a record $4.2 billion in fiscal 2012 from individuals and
companies trying to cheat the system.
For every dollar spent investigating healthcare fraud over
the past three years, the government recovered $7.90, according
to a report released on Monday by U.S. Attorney General Eric
Holder and Health and Human Services Secretary Kathleen
This was the highest three-year average return on investment
in the 16-year history of the federal Health Care Fraud and
Abuse Program, the report said.
Healthcare lawyers representing both providers and
whistle-blowers said the announcements echoed patterns they have
observed in their practices and that the trend toward more
rigorous enforcement has boosted business.
"We're doing more and more fraud and abuse work, and we also
work with providers like hospitals and doctors' offices who are
more concerned about compliance issues," said Robert Brennan, a
former prosecutor who now represents healthcare companies as a
partner in Parker Hudson Rainer and Dobbs in Atlanta.
"(Companies are) scared because if the government comes
knocking, it can mean big trouble for their business."
Lesley Ann Skillen, a partner in the New York firm Getnick
and Getnick, who has represented whistle-blowers in fraud cases
since the 1990s, said that the Justice Department has been
increasingly eager to work with firms such as hers.
"We bring them good cases, and success breeds more success,"
The Obama administration has stepped up investigations under
the program, making the prevention of fraud and waste in
healthcare a top priority. The Patient Protection and Affordable
Care Act authorized additional tools to fight fraud, including
tougher eligibility screening for Medicare providers, increased
data sharing among government agencies and greater oversight of
private insurance abuses.
Efforts to curb waste, fraud and abuse are also seen by
administration officials as a means to control healthcare
spending, as the White House and Congress prepare for the next
round of deficit reduction talks.
HCA Holdings Inc, the largest for-profit hospital operator
in the United States, said in August that federal authorities
were investigating whether heart procedures performed at some of
its facilities were medically necessary.
Federal spending for Medicare, Medicaid and other healthcare
programs is expected to hit $885 billion this year, according to
the nonpartisan Congressional Budget Office.
The $4.2 billion recouped in fiscal 2012 from those
attempting to defraud federal healthcare programs, including
Medicare for the elderly and Medicaid for the poor, was up from
nearly $4.1 billion the year before.
Over the past four years, the administration's enforcement
efforts have recovered $14.9 billion, more than double the $6.7
billion recouped over the previous four-year period.
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