OIG To Recover More Than $3 Billion in Healthcare Fraud Enforcement
In its semiannual report to Congress this week, the Department of Health and Human Service’s (HHS) Office of Inspector General (OIG) announced that it expects to recover more than $3 billion from enforcement activities conducted in the six-month period that ended March 31. In the same time period, the OIG:
- Excluded 1,935 individuals and entities from participation in federal health care programs;
- Brought 293 criminal actions against individuals or entities; and
- Initiated 164 civil actions (including some under the False Claims Act, unjust enrichment lawsuits, civil monetary penalties law settlements and administrative recoveries related to provider self-disclosure).
In the months ahead, the OIG will implement the healthcare fraud-related provisions in the Patient Protection and Affordable Care Act (PPACA) and oversee HHS’s healthcare reform activities. It will also continue its efforts with the Health Care Fraud Prevention & Enforcement Action Team (HEAT) in conjunction with the Department of Justice and HHS. HEAT initiatives include the Medicare Fraud Strike Force, which coordinates law enforcement operations with other federal, state and local law enforcement entities in select cities around the country.
Feds say they recovered $1 billion in fiscal 2008
The U.S. Justice Department and HHS’ inspector general’s office recovered $1 billion in judgments and settlements in fiscal 2008 for the federal government, according to the annual report of the Health Care Fraud and Abuse Control Program. Under the Health Insurance Portability and Accountability Act of 1996, the departments are required to coordinate and issue reports on their efforts to fight fraud perpetrated against federal health programs. The reports are generally issued about a year after the close of the fiscal year they cover. In fiscal 2008, about $1.94 billion was returned to the Medicare Trust Fund as a result of enforcement actions in that year and previous years, and $344 million in Medicaid funds was returned to the U.S. Treasury. U.S. attorneys, meanwhile, opened 957 new criminal cases involving healthcare fraud, filed criminal charges against 797 defendants and won 588 convictions. The Justice Department’s civil division opened 843 new healthcare fraud investigations.
Modern Healthcare by Gregg Blesch, October 23, 2009
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