Tuesday, January 24, 2017

HHS/DOJ Release 2016 Health Care Fraud and Abuse Control Program Report

The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) released its joint Health Care Fraud and Abuse Control Program Annual Report for FY 2016, focusing on the two agencies collaborative approach to identifying and prosecuting the most egregious instances of health care fraud, to prevent future fraud and abuse, and to protect program beneficiaries.

During FY 2016, the federal government won or negotiated over $2.5 billion in health care fraud judgments and settlements, resulting in over $3.3 billion being returned to the federal government. Of this $3.3 billion, the Medicare Trust Fund received approximately $1.7 billion during this period, and $235.2 million in federal Medicaid money was similarly transferred to the Treasury. The DOJ opened 975 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 480 cases involving 802 defendants; resulting in a total of 658 defendants being convicted of health care fraud-related crimes.

DOJ also opened 930 new civil health care fraud investigations and had 1,422 civil health care fraud matters pending at the end of the year. The HHS, Office of Inspector General (OIG) also conducted investigations that resulted in 765 criminal actions against individuals/entities that engaged in crimes related to Medicare and Medicaid, and 690 civil actions which include 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. OIG excluded 3,635 individuals and entities from participation in Medicare, Medicaid and other federal health care programs. Among these were exclusions based on Medicare or Medicaid criminal convictions (1,362) or to other health care programs (262), for patient abuse or neglect (299), and as a result of licensure revocations (1,448).

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