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.
Expect Stricter HIPAA Enforcement
The Department of Health and Human Services (HHS) announced that the Office for Civil Rights (OCR) will now be responsible for enforcing the Health Insurance Portability and Accountability Act of 1996 (HIPAA) security rule in addition to the privacy rule. (The Centers for Medicare & Medicaid Services was previously responsible for the security rule). This consolidation of HIPAA enforcement activity highlights the Administration’s heightened scrutiny of security and privacy of health information. In fact, the American Recovery and Reinvestment Act of 2009 mandates enhanced patient privacy rights and physician practice requirements, increased financial penalties for violations of the privacy rule and the security rules and allocated additional resources for enforcement.
How will this affect you? Well if your group practice has not yet put in place a plan to implement the Red Flag rules, you will be at risk of a HIPPA violation once the enforcement begins.
