U.S. Recovers $16 for Every $1 it Spends Fighting Civil Healthcare Fraud

For each dollar the federal government spends investigating and prosecuting civil healthcare fraud, it gets more than $16 in return, even after subtracting amounts paid to whistleblowers, according to a study from Washington, D.C.-based Taxpayers Against Fraud.

Combined civil, criminal and state recoveries under the False Claims Act from 2008 through 2012 total approximately $18.3 billion. Only federal civil returns under the FCA show a better than 16:1 return on investment, but a more robust calculation factoring both criminal and civil fines and recoveries would show an even greater return, according to the study.

"There is no doubt that the federal government's initiatives to fight healthcare fraud have returned large sums of money to U.S. taxpayers," wrote the report authors. "It is clear that the federal government is getting a tremendous 'bang for the buck' in its anti-fraud activities in healthcare."

Healthcare fraud cases under the FCA have grown significantly in recent years. There were 62 healthcare qui tam, or whistle-blower, cases recorded from 1987 to 1992, for instance. In 2011 alone, there were 417. Another 412 were recorded in 2012.

The report broke down the healthcare fraud recoveries since 1987. The government brought in $24 billion in settlements and judgments, with another $15 billion in criminal fines and civil settlements returned to the states. That brings the total amount recovered to date to nearly $40 billion.

That's a small portion of the country's $2.8 trillion annual healthcare spend, but still significant as evidenced by the below comparison.  

"To put that figure in perspective, it is enough money to fund the entire Children's Health Insurance Program, serving [more than] 5 million people, for approximately four years," according to the report.

More Articles on Healthcare Fraud:

Updated Fraud Self-Disclosure Protocol: 5 Considerations for Healthcare Providers
HHS Proposes $9.9M Reward for Reporting Medicare Fraud
GAO: Hospitals Most Common Subjects in Civil Healthcare Fraud Investigations

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