Health Information Management

OIG, DOJ negotiate more than $2.3 billion in healthcare fraud settlements

HIM-HIPAA Insider, March 30, 2015

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

by Jaclyn Fitzgerald, Editor


The HHS Office of the Inspector General (OIG) and the Department of Justice (DOJ) recently announced that the federal government won or negotiated more than $2.3 billion in healthcare fraud judgments and settlements in fiscal year (FY) 2014, according to a March 19 report.
 
Approximately $3.3 billion was returned to the federal government or paid out to private persons as a result of efforts by the OIG and DOJ to combat healthcare fraud and abuse in FY 2014 and preceding years. Of these dollars, approximately $1.9 billion was transferred to Medicare Trust Funds whereas more than $523 million in federal Medicaid funds were transferred to the U.S. Treasury. The Health Care Fraud and Abuse Control Program, which was established under HIPAA, has returned more than $27 billion to the Medicare Trust Funds since its inception in 1997, according to the report.
 
In FY 2014, the DOJ opened 924 new criminal healthcare fraud cases, federal prosecutors filed criminal charges in 496 cases, and convicted 734 defendants of healthcare fraud crimes. Similarly, the DOJ opened 782 civil healthcare fraud investigations.
 
In FY 2014, OIG investigations led to 867 criminal actions against individuals or entities for Medicare- or Medicaid-related crimes. OIG investigations also led to 529 civil actions for false claims and unjust-enrichment lawsuits, civil monetary penalty settlements, and administrative recoveries for matters related to provider self-disclosure. The OIG excluded more than 4,000 individuals and entities from participating in Medicare, Medicaid, and other federal healthcare programs due to federal healthcare program convictions or crimes, patient abuse or neglect, or licensure revocations.
 
For more information, view the fact sheet about the Medicare Fraud Strike Force.



Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular