The national Health Care Fraud and Abuse Control (HCFAC) Program raked in over $5 billion in healthcare fraud and abuse recoveries last year, according to the U.S. Department of Health & Human Services (HHS) and Department of Justice’s (DOJ’s) newly released Fiscal Year 2021 Report. Jointly run by the US Attorney General and HHS Secretary, HCFAC coordinates federal, state, and local health fraud enforcement activities.
In FY 2021, the DOJ opened 831 new criminal healthcare fraud investigations and federal prosecutors filed criminal charges in 462 cases involving 741 defendants, resulting in the conviction of 312 defendants. The DOJ also opened 805 new civil healthcare fraud investigations while the FBI helped take down more than 107 healthcare fraud criminal enterprises.
Investigations carried out by the HHS Office of Inspector General (OIG) resulted in 504 criminal actions for Medicare and Medicaid fraud, along with 669 civil actions, including false claims and unjust-enrichment lawsuits and civil monetary penalty (CMP) settlements. OIG also excluded 1,689 individuals and entities from participation in Medicare, Medicaid, and other federal healthcare programs. Among these, 569 exclusions were based on criminal convictions for crimes related to Medicare and Medicaid and 267 exclusions were for crimes to other healthcare programs.