U.S. recovers $4 billion from health-care fraud cases

The White House is dismissing a vote by House Republicans to repeal the new health care law, saying it's not "a serious legislative effort."
Washington Post Staff Writer
Monday, January 24, 2011; 8:11 PM

The government recaptured a record $4 billion last year from pharmaceutical companies, hospitals, doctors, nursing homes and other providers of care that defrauded federal health-care programs, the Obama administration reported Monday.

Administration officials also called attention to new federal rules intended to prevent fraud - or detect it early - that took effect Monday as a result of the law enacted last year to overhaul the health-care system.

The annual report arrives as the new Republican leaders in the House are planning congressional investigations, suggesting that the administration is not aggressive in pursuing government waste and fraud.

"We can save $125 billion in simply not giving out money to Medicare recipients that don't exist for procedures that didn't happen," Rep. Darrell E. Issa (R-Calif.), the new chairman of the House Oversight and Government Reform Committee, said this month. Facing a hostile climate in the House, several senior aides to President Obama heavily touted what Health and Human Services Secretary Kathleen Sebelius called "unprecedented work to safeguard taxpayer dollars."

During the fiscal year ended in September, the report says, the government recovered $4.02 billion from fraud cases completed during that year or in the past. That sum compares with $2.6 billion recovered in fiscal 2009 and slightly more than $2 billion in 2008. Nearly three-fourths of the total recouped last year was from fraud against Medicare, the federal health insurance for older Americans. The figures also show that the government won court judgments and out-of-court settlements last year amounting to $2.5 billion, although not all that money has been collected.

According to Justice Department statistics, the number of new criminal and civil investigations of potential health-care fraud, most involving Medicare, increased slightly last year. And the number of defendants convicted of such fraud grew to more than 700 in 2010 from fewer than 600 the previous two years.

Less than a week after the Republican-led House voted to repeal the new health-care law, administration officials continued to focus attention on provisions they think the public will like.

Sebelius pointed out that the new rules authorized by the law, which took effect Monday, require more thorough screenings for health-care workers, companies and institutions that want to participate in Medicare, Medicaid or the Children's Health Insurance Program. And if such participants are accused of fraud, government officials can stop payments to them while they conduct an investigation.

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