The federal government recovered more than $5 billion in healthcare fraud settlements and judgments in fiscal year 2021, according to the joint annual government Health Care Fraud and Abuse Control Program Annual Report from the of the Departments of Justice and Health and Human Services.
It was the largest amount of money ever recovered by the HHS and DOJ's fraud and abuse enforcement program.
The DOJ opened 831 new criminal healthcare fraud investigations in FY 2021, with judgements and settlements returning almost $1.9 billion to the federal government or to private citizens through payments.
Of the nearly $2 billion, $1.2 billion went into the Medicare trust fund, while nearly $98.6 million was transferred to the CMS, the report stated.
Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, with a total of 312 defendants convinced in FY 2021 of healthcare fraud-related crimes.
WHY IT MATTERS:
The Health Care Fraud and Abuse Control Program was established as part of HIPAA with the aim to help the DOJ and HHS coordinate efforts to uncover and stamp out fraud and abuse in the healthcare industry.
In August, Sutter Health agreed to pay the federal government $90 million to settle allegations that it submitted false information about its Medicare Advantage beneficiaries.
In September 2021, Independent Health, DxID allegedly inflated MA reimbursement through unsupported diagnosis codes in violation of the False Claims Act.
At the start of 2021,...
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