Washington - The U.S. Department of Justice recovered a record $3.1 billion in fraudulent claims in fiscal 2006, with 72 percent of the recoveries in health care. A single hospital chain, Dallas-based Tenet Healthcare Corp., paid back $920 million in one of the year’s largest settlements with the federal government, according to the Justice Department.
Although Medicare and Medicaid bear the brunt of health care fraud against the government, the Justice Department says, other affected programs include Federal Employees Health Benefits, TRICARE military health insurance and health care programs run by the Department of Veterans Affairs, the Department of Labor and the Railroad Retirement Board.
In a larger context, the Justice Department recoveries occurred in the face of about $29 billion in fraud perpetrated last year upon the property and casualty insurance industries. That figure does not take into account the fraudulent claims filed in the life and health insurance industries.
Insurers are retaliating by setting up special investigative units (SIU) inside their companies, says the Insurance Information Institute. SIU’s often aim to discover fraudulent claims before they’re paid, industry observers say.
As a tool for SIUs the industry has developed automated reporting systems. The systems, which replace manual approaches, help investigators solve or prevent costly crimes.
Sources: U. S. Justice Department and Insurance Networking News reports
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