The U.S. Department of Health and Human Services Office of Inspector General expects to recover $4.9 billion in improper Medicaid and Medicare payments in 2014, down from $5.8 billion recoveries in 2013.
Of the expected recoveries, $4.1 billion stem from investigative work by the government and about $830 million result from program audits, according to a December announcement by the OIG.
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While recoveries were slightly down from last year, exclusions from federal programs rose, according to the report to Congress. In 2014, the OIG excluded 4,017 health providers from participating in federal health care programs, up from 3,214 in 2013. The OIG also took 971 criminal actions against individuals or health care entities that allegedly engaged in crimes against programs such as Medicare and Medicaid. Courts weighed in on 533 civil and administrative cases in 2014, including false claims and unjust-enrichment lawsuits. Administrative cases included both OIG-initiated actions and provider self-disclosure cases. In comparison, the OIG took 960 criminal actions and 472 civil actions against health care providers in 2013.
Significant overpayment cases in 2014 included a six-state seizure by the Medicare Fraud Strike Force in May 2014 that resulted in charges against 90 health care providers, including physicians, for their alleged participation in Medicare fraud schemes totaling $260 million. The OIG also accepted an $85 million settlement from Daytona Beach, Fla.–based Halifax Hospital Medical Center to resolve allegations that Halifax entered into prohibited contracts with oncologists and neurosurgeons in violation of the Stark Law, resulting in the submission of false claims.
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