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February 28, 2024
David Burda
Economics Policy System Dynamics

Justice Department Sleeping at the Healthcare Fraud Wheel

In a 4sight Health blog post published last month, I said there were only two possible reasons why the dollar amount of healthcare civil fraud and false claim settlements and judgments collected by the U.S. Department of Justice (DOJ) dropped dramatically in fiscal 2022:

  • Companies and organizations that contract with Medicare, Medicaid and other federal healthcare programs are committing less fraud.
  • The DOJ is doing a poorer job detecting and penalizing companies and organizations that commit fraud.

I said we’d know the answer when the DOJ released its fiscal 2023 stats this month. We have our answer. The DOJ is mailing it in, asleep at the wheel, falling down on the job, pick your expression.

Here are the DOJ stats released on Feb. 22 for civil fraud and false claims settlements and judgments recovered for taxpayers by the agency in fiscal 2023, or from Oct. 1, 2022, through Sept. 30, 2023:

  • Total civil fraud and false claim settlements and judgments for all federal agencies, including the U.S. Department of Health and Human Services (HHS), rose nearly 20% to about $2.7 billion in fiscal 2023 from about $2.2 billion in fiscal 2022. The amount collected was still less than half of the more than $5.7 billion collected in fiscal 2021.
  • Healthcare civil fraud and false claim settlements and judgments involving HHS rose just 1.5% to a little over $1.8 billion in fiscal 2023 from a little less than $1.8 billion in fiscal 2022. The amount collected was well off the record of more than $5.1 billion collected in fiscal 2021.
  • Healthcare civil fraud and false claim settlements and judgments involving HHS in fiscal 2023 represented 67.6% of total settlements and judgments, down from 79.9% in fiscal 2022 and 89.6% in fiscal 2021.
  • The dollar value of the healthcare civil fraud and false claim settlements and judgments in fiscal 2023 was the second lowest total in the past 10 years with fiscal 2022 being the lowest.

I guess you still could argue that there’s less fraud and, thus, less fraud recoveries. But when the DOJ collected double and triple the amounts in past years, it’s a tough argument to make.

If you’re reporting on or writing about the DOJ’s new false claims numbers, skip the press release and go right to the attached spreadsheets. That’s where you find the real story of what’s happening. And from a taxpayer perspective, what’s happening isn’t much.

Thanks for reading.

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About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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