Federal government recoups record amount in Medicare fraud

Federal health officials Monday said they recouped a record high $4 billion last year in Medicare and Medicaid fraud and introduced tighter measures to clamp down on criminal activity in the future. More than half of the money has been returned to the Medicare Trust Fund.

The findings are part of annual report released by the Health and Human Services Department and the Justice Department. The two agencies operate the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, which has cracked down on abuse in the health care system.

As of 2010, federal prosecutors have opened 1,116 criminal health care fraud investigations and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes in that time.

Also on Monday, HHS and its Medicare division released new regulations requiring stricter screenings for health care providers, higher penalties for those who commit fraud, stoppage of payment for providers who are under investigation, and $360 million in new funding to shore up on-the-ground efforts. The nearly 1-year-old health care law called for tougher fraud-fighting measures.

The provisions are meant to make federal health officials more proactive in stemming fraud and abuse, moving them from a "pay-and-chase" model to one that aims to keep criminals on the defensive.

"If you're stealing from every American taxpayer ... you should be punished accordingly," HHS Secretary Kathleen Sebelius said about the tougher enforcement measures.