On Feb. 14, 2011, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) sent Valentine’s Day greetings by announcing that in fiscal year 2011, the agencies recovered approximately $4.1 billion from joint enforcement efforts. The statistics demonstrate the agencies’ continued commitment to combating health care fraud and abuse:
- 1,110 new criminal investigations (targeting 2,561 potential defendants) opened
- 1,873 health care fraud prosecutions (targeting 3,118 potential defendants) pending
- 489 new criminal cases (against 1,430 named defendants) filed
- 743 defendants convicted of health care-related crimes
Many criminal matters also have a parallel civil counterpart, and the FY 2011 report also noted that in the same timeframe, DOJ opened 977 new civil health care fraud investigations, adding to its 1,069 pending matters. These include qui tam matters and False Claims Act complaints lodged by whistleblowers. HHS also announced that in FY 2011 alone, it exercised its mandatory exclusion authority to exclude 2,662 individuals and entities from federal health care benefit programs.
The FY 2011 numbers demonstrate a continued increase in health care fraud prosecutions and civil lawsuits. This likely results from an increasingly coordinated effort by law enforcement to work together and share resources. For years, those involved in the health care industry were far more knowledgeable about the regulatory framework than were prosecutors and law enforcement agents. However, with every prosecution or civil lawsuit, another government employee becomes an expert—at least in the sector at issue in his investigation.