Federal officials recovered $4 billion in taxpayer funds from fraud and prevention efforts in FY 2010, the highest amount ever, and more evidence of the high priority this effort has for the current administration.
"President Obama has made it very clear that fraud and abuse of taxpayers' dollars are unacceptable," said Health and Human Services Secretary Kathleen Sebelius in a statement. "And for too long, our fraud prevention efforts have focused on chasing after taxpayer dollars after they have already been paid out.
Sebelius credited the Patient Protection and Affordable Care Act with providing new legal tools to help in the recovery of fraud, abuse and waste of federal healthcare dollars.
These include enhanced provider eligibility screening and Medicare and Medicaid program enrollment requirements, increased data sharing across government agencies, expanded overpayment recovery efforts and greater oversight of abuses by private insurance companies.
Director of the Centers for Medicare and Medicaid Services, Donald Berwick, said the new law that gives more power to fight fraud, and to "develop sophisticated, new systems of monitoring and oversight to not only help us crack down on fraudulent activity scamming these programs, but also help us to prevent the loss of taxpayer dollars across the board for millions of American healthcare consumers."
Medicare Fraud Strike Force Teams have expanded since 2009, which aided in the recovery, the statement said.
The funds recovered include $590 million, which resulted from 140 indictments involving charges against 284 defendants who collectively billed the Medicare program improperly or inappropriately.
Also, the government obtained 217 negotiated guilty pleas, litigated 19 jury trials and won guilty verdicts against 23 defendants.
During the fiscal year, 146 defendants were imprisoned, with incarceration sentences averaging more than 40 months.
Specifically, the new rules promulgated by the legislation will allow Medicare, Medicaid and the Children's Health Insurance Program to screen providers who classified in a group that has a higher risk of fraud, such as durable medical equipment suppliers.
Providers also have tougher screening requirements, and barred from participation if they have ever been kicked out of any state program.
Modeling software may now be used to identify trends that may point to fraudulent practices, similar to models that look for credit card fraud.
Rather than attempt to recover money after it has been found to be fraudulently reimbursed for invalid claims, the new law allows the government to temporarily stop payments when their practices are suspected of being fraudulent. "Under the new rules, if there has been a credible fraud allegation, payments can be suspended while an action or investigation is underway."