Fraud and Abuse Investigations Should be Taken Very Seriously

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Reprinted with Permission from the Medical Association of the State of Alabama

According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report, released by the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) on January 18, 2017, the federal government recovered more than $3.3 billion in fraudulent health care claims in Fiscal Year (FY) 2016. That means for the last three years for every one dollar invested into the Program it generated a five dollar return.

Established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HCFAC Program was designed to identify and prosecute health care fraud and abuse through the coordination of federal, state, and local law enforcement activities. Since its inception in 1997, the Program has returned close to $31 billion to the Medicare Trust Funds.

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