Health care top source of fraud recoveries

A few multimillion-dollar settlements with health care firms played a major role in the federal government's recoupment of money.

By Tanya Albert, AMNews staff. Dec. 10, 2001.

During the past fiscal year, the U.S. government collected more money in the form of fraud recoveries than ever before -- $1.6 billion. And most of that money -- $1.2 billion -- came from health care fraud cases, according to Dept. of Justice statistics released in November.

That's 75% of the money collected.

"The cost of health care fraud is immense, both in terms of taxpayer dollars and the quality of care provided," Assistant Attorney General Robert D. McCallum Jr. of the Justice Dept.'s civil division said in a statement. "Although the vast majority of health care providers are honest and provide the highest standard of care, we cannot allow those who aren't to deplete critical federal funds or to endanger those who depend on federal health care programs."

The Justice Dept. does not break down its figures within the health care sector, so physician numbers are not available.

A large portion of the recoveries came from a handful of cases against hospital and nursing home companies that were settled between Oct. 1, 2000, and Sept. 30, 2001, including:

• A $745 million settlement with the for-profit hospital chain, HCA-The Healthcare Company, based in Nashville, Tenn. Accusations included falsely billing Medicare.
• Recovery of $104 million from Quorum Health Group, based in Brentwood, Tenn., for allegedly submitting false cost reports.
• Recovery of $103 million from Vencor, a nursing home chain based in Louisville, Ky., for alleged false claims to Medicare, Medicaid and the military health care program.