Government Anti-Fraud Efforts Garner $2.3 Billion in 2018
- In its annual report issued for 2018, the Health Care Fraud and Abuse Control (“HCFAC”) Program indicated that its anti-fraud efforts consisting of fines, forfeitures, and restitution had resulted in recoveries in excess of $2.3 billion.
- The Program, which was established by the Health Insurance Portability and Accountability Act of 1996, is jointly operated by the U.S. Department of Justice (“DOJ”) and U.S. Health and Human Services’ (“HHS”) Office of Inspector General (“OIG”). The goal of the Program is to coordinate federal, state, and local law enforcement activities with respect to health care fraud and abuse.
- The report includes information on criminal convictions – nearly 500 defendants were convicted of fraud-related crimes in 2018. The OIG also excluded 2,712 individuals and entities from participating in Federal health care programs due to fraudulent activities.
- In addition to financial recoveries and criminal convictions, the report also indicated the OIG issued 212 recommendations to HHS operating divisions, with the goal of generating additional cost savings to those divisions. The OIG’s position as reflected in the report indicates HHS could recognize $777 million in potential savings if the agency implemented all of OIG's recommendations.
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Thomas D. Anthony is the former chair of FBT's Health Care Industry Team. He focuses on counseling health care entities on corporate transactions, regulatory compliance and joint ventures.