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Medicare Fraud Crackdown Brings in $3.3B Billion in 2014

Medicare fraud is an unfortunate reality, but a newly released annual report from the Department of Justice and the Department of Health and Human Services shows that the federal government is making progress in reducing fraud. Last year, a joint effort by the two federal agencies saw the recovery of $3.3 billion out of which Medicare would have otherwise been defrauded.

The Health Care Fraud Prevention & Enforcement Team

The Health Care Fraud Prevention and Enforcement Team (HEAT), was established during President Obama’s first year in office, with the goal of finding fraudulent Medicare claims. HEAT was a strengthening of efforts already underway between the Justice Department and Health and Human Services to fight Medicare fraud. The two agencies launched a joint Medicare anti-fraud program in 1997, which has returned $27.8 billion to the Medicare Trust Fund since then.

In 2015, HEAT brought a total of $3.3 billion back to the federal government. $2.3 billion came from health care fraud judgments won in court, and administrative punishments accounted for the rest. Here’s how it was distributed:

2015 HEAT Distribution

  • $1.9 billion was returned to the Medicare Trust Fund.
  • $1.2 billion went to the U.S. Treasury.
  • $370 million went to whistleblowers for helping expose fraud.
  • $155 million went to the Pentagon’s Tricare program (the DoD health clinic at the Pentagon), the Office of Personnel Management (which recruits and retains federal employees), and the Department of Veterans Affairs.

What are some examples of Medicare fraud?

There are a myriad of ways in which people seek to defraud Medicare.

In a recent example out of Los Angeles, a pharmacist plead guilty to health care fraud after he “paid illegal cash kickbacks to Medicare beneficiaries to persuade them to have their prescriptions filled at his pharmacy…and also submitted false and fraudulent claims to Medicare Part D plan sponsors for prescriptions he did not fill, according to the DOJ.”

In another example from Government Executive, “In one case in Murfreesboro, Tenn., a husband and wife in January 2014 received a 12-year sentence for billing Medicare and Medicaid $1.2 million for ambulance services for patients who did not qualify and for transporting multiple patients at a time by seating some in the front seat.”


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