Dive Brief:
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The U.S. government announced that it has recovered $3.3 billion that was fraudulently obtained from federal healthcare programs in fiscal year 2014, which ended Sept. 30.
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The administration has been increasing efforts to crack down on fraud as well as shortening the time between the discovery of fraud and making an arrest.
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The Department of Health and Human Services announced that the administration recovered $7.70 per dollar spent going after healthcare fraud during the last three years, making this the third-highest return on investment since the anti-fraud program was launched nearly two decades ago.
Dive Insight:
This is good news for the sake of cost control. More than $27.8 billion has been recovered and returned to the Medicare Trust Funds since 1997, the HHS report highlights.
However, as the Wall Street Journal notes, fraud recovery still presents a formidable challenge given that about 4.5 million claims are processed each day and as much as 10% of annual Medicare spending is estimated to be fraudulent. In 2013 alone, for example, Medicare spent about $583 billion. While about $58 billion of that is estimated to have been fraudulent, only $2.86 billion was recovered.
The higher 2014 recoveries are said to reflect the administration's move from chasing down cases to focusing on prevention, such as revoking billing privileges from providers with a history of inappropriate billing, and verifying the legitimacy of the providers in the program.