The Department of Health and Human Services (DHHS) and The Department of Justice (DOJ) Health Care Fraud and Abuse Control (HCRAC) Program Annual Report for Fiscal Year 2013 (Report) was released this week.  The Report states that the DHHS and DOJ recovered $4.3 billion in health care fraud judgments and settlements in fiscal year 2013.  Some interesting statistics from the Report include the following:

  • DOJ opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants and had 2,041 health care fraud criminal investigations pending

  • DOJ opened 1,083 new civil health care fraud investigations and had 1,079 civil health care fraud matters pending

  • DHHS’ Office of Inspector General (OIG) investigations resulted in 849 criminal actions and 458 civil actions

  • OIG excluded 3,214 individuals and entities for criminal convictions related to Medicare and Medicaid (1,132) or other health care programs (311); patient abuse or neglect (180); and as a result of licensure revocations (1,324)

  • Over $324 million paid to False Claims Act whistleblowers

The Report also states that the return-on-investment (ROI) for the HCFAC Program for years 2011-2013 is $8.10 returned for every $1.00 expended by the government. This strong ROI further reinforces that the government will continue to expend resources to combat fraud, waste and abuse in the health care industry.