Health and Human Services & DOJ Report Record Healthcare Fraud Year

In yesterday’s post, we began examining the recent report offered jointly by the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) with regard to their accomplishments in combatting wasteful healthcare fraud. In fiscal year 2014, a whopping $3.3 billion was recovered on behalf of taxpayers as a result of healthcare fraud settlements and verdicts, making this one of the top areas for recovery under the False Claims Act.

In today’s post, we will look at the details provided in the report with regard to the individual efforts by both HHS and DOJ. These hardworking groups not only provide the investigative and auditing services necessary to uncover the existence of fraud, but litigate and settle the matters as quickly and efficiently as possible.

Activity and accomplishments of the Department of Health and Human Services

In fiscal year 2014, $199 million was earmarked for the Office of Inspector General within HHS – the agency responsible for conducting in-depth investigations of alleged healthcare fraudsters. Using these funds, HHS-OIG was able to initiate 867 criminal actions and 529 civil actions against corporations and individuals caught defrauding the government. Accordingly, over 4,000 companies and providers were excluded from Medicaid and Medicare reimbursement eligibility

Exclusions are one of the top remedies available to combat healthcare fraud, as treating Medicare and Medicaid enrollees is a major component to the financial strength of modern providers and practitioners. In 2014, 4,017 providers were excluded for the following reasons:

• Criminal Medicare and Medicaid fraud
• Patient abuse and neglect
• License revocations
• Distribution of controlled substances
• Sexual assault of sedated patients

Other anti-fraud tactics used by HHS include civil monetary penalties, audits and evaluations, and industry outreach and guidance.

Department of Justice activities and accomplishments

The Department of Justice was allocated $40.7 million in fiscal year 2014 to settle and litigate claims of fraud within the healthcare industry. These funds employed 93 U.S. Attorneys and their assistants. In its report, DOJ noted that its referrals come in large part from confidential reports made by whistleblowers under the False Claims Act – which, as noted yesterday, resulted in $369 million in total rewards for qui tam plaintiffs.

An additional $27.1 million was allocated to the DOJ’s civil division, primarily earmarked for Commercial Litigation Branch’s Fraud Section, the Consumer Protection Branch, and the Elder Justice Initiative. Within the commercial litigation branch, an impressive $1 billion (or more) has been recovered from healthcare cases almost every year since 2000, with $2.3 billion recovered in 2014 alone.

Interestingly, the Organized Crime and Gang Division took part in the prosecution of several healthcare fraud cases, which were handled by just four attorneys nationwide. These cases focused primarily on fraud involving healthcare plans and resulted in settlements totaling hundreds of millions of dollars.

Contact us to learn more

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