Crackdown on Medicare Fraud Brought back $3.3 Billion in One Year

Tuesday, March 24, 2015
Kathleen Sebelius and Eric Holder, 2011 (photo: Jose Luis Magana, AP)

Under President Barack Obama, a federal program to fight Medicare fraud has helped the government retrieve more than $3 billion in 2014.


During Obama’s first year in office, the Health Care Fraud Prevention & Enforcement Action Team (HEAT) was established to pursue phony Medicare claims. Spearheaded by Attorney General Eric Holder and then-Health and Human Services Secretary Kathleen Sebelius, HEAT ramped up an 18-year effort by the Department of Justice and the Department of Health and Human Services (HHS) to battle Medicare fraud.


During 2014, with the help of state and local law enforcement, HEAT generated $3.3 billion in civil judgments and other monies, according to the new annual report (pdf) released by the two federal departments.


Of the $3.3 billion recovered, $1.9 billion was funneled back into the Medicare Trust Fund and $1.2 billion went to the U.S. Treasury. About $155 million in damages was awarded to the Pentagon’s Tricare program, the Office of Personnel Management and the Department of Veterans Affairs).


Whistleblowers collected $370 million of the funds for helping expose Medicare fraud.


Examples of Medicare fraud include inflating ambulance charges and selling only partially filled vials of breast cancer treatment medication, according to Government Executive.


“In one case in Murfreesboro, Tenn., a husband and wife in January 2014 received a 12-year sentence for billing Medicare and Medicaid $1.2 million for ambulance services for patients who did not qualify and for transporting multiple patients at a time by seating some in the front seat,” the publication’s Charles S. Clark wrote.


Since the Justice Department and HHS launched the Medicare anti-fraud program in 1997, it has brought back $27.8 billion to the Medicare Trust Fund. Last year’s recoupment included more than $2.3 billion in health care fraud judgments that were either won in court or negotiated, in addition to administrative punishments for fraudulent crimes.

-Noel Brinkerhoff, Danny Biederman


To Learn More:

Health Care Fraud and Abuse Control Program FY 2014 (Departments of Justice and Health and Human Services) (pdf)

Justice, HHS Recover $3.3 Billion from Medicare Fraudsters (by Charles S. Clark, Government Executive)

Cuban Criminals Exploit 1966 Law to Commit Health Care Fraud and other Financial Crimes (by Steve Straehley, AllGov)

Nation’s Worst Cancer Doctor Pleads Guilty to Medicare Fraud (by Noel Brinkerhoff, AllGov)

2% of Doctors Received 24% of Medicare Payments (by Noel Brinkerhoff, AllGov)

Justice Department Joins Rare Lawsuit against Hospital CEO for Defrauding Medicare and Medicaid (by Matt Bewig, AllGov)


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