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January 10, 2024
David Burda
Economics Policy System Dynamics

Less Healthcare Fraud or Less Healthcare Fraud Detection?

Nearly a year ago, I missed a big story.

Every February, the U.S. Justice Department (DOJ) releases an annual report on the civil False Claims Act settlements and judgments the agency made the previous fiscal year. The report is a yearly barometer on who is trying to defraud the federal government and how hard the DOJ is trying to stop it. Most of the activity on both sides of that equation happens in healthcare.

Last February, I missed the DOJ’s release of the annual tally of civil fraud and false claims settlements and judgments that the agency made in fiscal 2022, which ran from Oct. 1, 2021, through Sept. 30, 2022. I’m sorry.

Here’s what I missed:

  • Total civil fraud and false claim settlements and judgments for all agencies, including the U.S. Department of Health and Human Services (HHS), dropped by more than half to about $2.2 billion from more than $5.7 billion in fiscal 2021.
  • Healthcare civil fraud and false claim settlements and judgments involving HHS plummeted to about $1.8 billion from more than $5.1 billion in fiscal 2021.
  • Healthcare civil fraud and false claim settlements and judgments involving HHS represented 79.8% of total settlements and judgments, down from 89.7% in fiscal 2021.

Why the dramatic change? There are only two possibilities.

One, companies and organizations that contract with Medicare, Medicaid and other federal healthcare programs committed less fraud. Two, the DOJ did a poorer job detecting and penalizing companies and organizations that committed fraud.

We’ll get a clearer picture of what’s going on next month when the DOJ releases its next annual report on the agency’s civil fraud and false claim settlements and judgments for fiscal 2023. I won’t miss it this time.

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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