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.

To learn more about this topic, please read:

• “Fighting Fraud Instead of Election Results”
• “Want to Stop the Steal? Start with Healthcare Fraud”
• “Fun with Fraud Numbers”