Report: HHS OIG fraud recoveries on the rise

Medicaid fraudThe Department of Health and Human Services Office of the Inspector General recently released its semi-annual Report to Congress outlining its anti-fraud activities. The report highlights OIG’s accomplishments for the six-month period ending March 31, 2016.

The agency noted that during that period it reported expected recoveries of more than $2.77 billion consisting of nearly $554.7 million in audit receivables and $2.22 billion in investigative receivables.

There were 428 criminal actions reported against individuals or entities engaged in crimes relating to healthcare fraud and another 383 civil actions, such as false claims and unjust enrichment lawsuits, filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.

Participating in fraudulent activities can get providers kicked out of participating in federal programs such as Medicare and Medicaid. HHS reported 1,662 individuals and entities were excluded.

The agency reports that civil monetary recoveries have increased almost five-fold in the past three years. During the six-month period, OIG concluded cases involving more than $43.8 million in civil monetary penalties.

OIG investigations, including work on Strike Force cases, focus on emerging patterns of fraud. The Strike Force team, which was launched in 2009, operates in ten cities, including Miami and Tampa. During the first half of FY 2016, its efforts resulted in the filing of charges against 87 individuals or entities, 100 criminal actions and $116.8 million in investigative receivables.

The report also compiles and summarizes the various individual reports OIG published over the first half of FY 2016 relating to its efforts to reduce waste or inefficiency found in federal healthcare programs.

For example, the report criticizes CMS for failing to perform required closeouts of contracts worth billions of dollars. The report notes: “Because the closeout process is generally the last chance for improper contract payments to be detected and recovered, delays in the closeout process pose a risk to government funds.

OIG has been actively and aggressively pursuing those that it believes are violating the law. The agency focuses on matters relating to everything for unnecessary billing to kickbacks to off-label marketing of prescription drugs. Anyone who participates in such illegal activity faces fines, jail time and exclusion from participating in federal healthcare programs.

Targets of these investigations include not only physicians, but also hospitals, pharmacies, psychiatric and psychological services, personal care services, laboratories, durable medical equipment companies, hospice care, and transportation services.

The Health Law Offices of Anthony C. Vitale represents clients facing allegations of fraud and abuse, compliance counseling and the defense of civil, administrative, regulatory and criminal healthcare fraud, including internal/defense investigations; False Claims Act litigation; settlement negotiations; withholding of Medicaid/Medicare payments; Overpayments; exclusion from participation in Medicare/Medicaid programs; licensure and certification; DEA registration, anti-kickback violations; medical necessity issues; Qui Tam investigations (whistleblower), prosecutions and defense; healthcare contracts, and physician self-referral (Stark).

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