Health Care Fraud and Abuse Control Program
GAO, September 2013 In fiscal year 2012, the Department of Health and Human Services (HHS), HHS Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) obligated approximately $583.6 million to fund Health Care Fraud and Abuse Control (HCFAC) program activities. HHS, HHS-OIG, and DOJ use several indicators to assess HCFAC activities, as well as to inform decision-makers about how to allocate resources and prioritize those activities. For example, in addition to other indicators, the United States Attorneysā Offices use indicators related to criminal prosecutions, including the number of defendants charged and the number of convictions. Additionally, many of the indicators that HHS, HHS-OIG, and DOJ useāsuch as the dollar amount recovered as a result of fraud casesāreflect the collective work of multiple agencies since these agencies work many health care fraud cases jointly. Outputs from some key indicators have changed in recent years. For example, according to the fiscal year 2012 HCFAC report, the return-on-investmentāthe amount of money returned to the government as a result of HCFAC activities compared with the funding appropriated to conduct those activitiesāhas increased from $4.90 returned for every $1.00 invested for fiscal years 2006- 2008 to $7.90 returned for every $1.00 invested for fiscal years 2010-2012. GAO report (70 pages): http://www.gao.gov/assets/660/658344.pdf
Comment:
By Don McCanne, M.D. You frequently hear people say that we could control health care costs if we were to get rid of fraud and abuse, as if efforts were not already underway to do so. Our government is spending over half a billion dollars on fraud detection with a recovery of almost eight dollars for every dollar spent. Furthermore, fraud is being detected in earlier stages, preventing further loss, which is more effective than limiting recovery to āpay and chaseā approaches (trying to recover losses after the funds were distributed). Also, CMS was able to revoke or deactivate the billing privileges of tens of thousands of providers that did not meet Medicare requirements. The point is that we canāt let single payer opponents dismiss the need for the adoption of more efficient health care financing methods by saying that we merely need to eliminate fraud and abuse. We need single payer if we are going to achieve real savings.
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