The Department of Health and Human Services has been under close scrutinization since the implementation of the Affordable Care Act and its accompanying internet portal healthcare.gov.
Notwithstanding this unprecedented, unexpected public scrutiny, the HHS has published for public review a report of its goals and aspirations through 2018, which include the goal to eliminate fraud, waste and abuse of the healthcare system. As you know, we regularly report on cases involving fraud brought to light by whistleblowers under the federal False Claims Act (and its state-level counterparts). In today’s post we examine one of the four components of HHS’s strategic plan as well as its proposed strategies to minimize and abolish healthcare-related misconduct. As always, if you are aware of this type of abuse either as a patient or an employee of the healthcare system, do not hesitate to contact a whistleblower attorney with your information.
Goal One: Fight Fraud, Waste and Abuse
The HHS’s Office of Inspector General has been involved in a vast number of whistleblower cases, making it the ideal agency to weigh in on the best ways to eliminate healthcare fraud. As outlined in its report, the OIG plans to implement a multi-faceted approach to fighting fraud, which is delineates by priority as listed below:
Identify, Investigate and Take Action: The OIG plans to use risk assessments of current or emerging issues to identify suspected fraud, followed by a calculated empowerment of investigative and enforcement resources to stop the misconduct. It plans to continue the use of criminal and civil penalties, settlements and administrative actions to invoke financial penalization of such conduct, as well as build on successful models of fraud detection and elimination. The OIG will continue its use of the Medicare Strike Force and will focus heavily on fraud within the Medicare and Medicaid systems.
Hold Wrongdoers Accountable and Maximize Recovery of Public Funds: In the area we are most interested in, the OIG plans to continue its strong partnership with the Department of Justice in furtherance of the Medicare Fraud Strike Force Team in order to implement to goals of the Health Care Fraud and Abuse Control program (HCFAC). The HCFAC boasts an impressive recovery of $7 for every $1 invested, we well as protects taxpayers by implementing criminal convictions and provider exclusions to prevent further mishaps. The HCFAC will focus on identifying and recovery improper payments and excluding providers found to be engaging in improper activity.
Prevent and Deter Future Fraud and Waste: In order to deter others from engaging in fraudulent activity, the OIG plans to educate other agencies as to the existence of grant fraud, as well as provide training to those in the healthcare industry as to how to best recognize and report fraud.
You Can be Part of the Five-Year Plan
By reporting suspicious activity within the healthcare industry to your whistleblower attorney, you stand a chance to not only eliminate this type of costly misconduct, but you could receive a sizable reward for your efforts. Under the FCA, whistleblowers can obtain up to 30 percent of any amount recovered. When we work together to fight fraud, we ultimately keep costs low for taxpayers as a whole as well as help reduce the skyrocketing costs of healthcare.