The U.S. government appears to be making a dent in health care fraud and abuse. The Departments of Justice and Health and Human Services announced that in fiscal 2013 the federal government’s health care fraud prevention and enforcement efforts recovered a record-breaking $4.3 billion, up from $4.2 billion in fiscal 2012.

The annual Health Care Fraud and Abuse Control (HCFAC) Program report also showed that for every dollar spent on health care-related fraud and abuse investigations through this and other programs in the last three years, the government recovered $8.10--the highest three-year average return on investment in the 17-year history of the HCFAC Program. Over the last five years, the report also noted that the Obama Administration’s enforcement efforts have recovered $19.2 billion, up from $9.4 billion over the prior five-year period. 

In a joint press release, DOJ and HHS stated that these results "demonstrate President Obama’s commitment to making the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration," adding that this is the fifth consecutive year that the program has increased recoveries over the previous year, increasing from $2 billion in fiscal 2008 to more than $4 billion every year since fiscal 2011.

However, a September 2013 report from the Government Accountability Office found that there is a lack of information about the effectiveness of HCFAC activities in reducing health care fraud and abuse. "The indicators agencies use to track HCFAC activities provide information on the outputs or accomplishments of HCFAC activities, not on the effectiveness of the activities in actually reducing fraud and abuse," concluded the GAO. 

But assessing the impact of the HCFAC program is challenging, argued government auditors in their report, because it’s difficult to isolate the effect of HCFAC activities from other efforts, such as changes to the Medicare provider enrollment process. In addition, auditors said it’s difficult to estimate a health care fraud baseline--a measure of the extent of fraud--that is needed to be able to track whether the amount of fraud has changed over time as a result of HCFAC and other anti-fraud initiatives. 

Congress established the HCFAC program in 1997 and provided funding to HHS and DOJ to help reduce fraud and abuse in Medicare and Medicaid. The GAO has designated Medicare and Medicaid as high-risk programs due to their size, scope, and complexity.

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