Health Information Management

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

HIM-HIPAA Insider, March 30, 2015

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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.

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