On April 6, 2018, the U.S. Department of Justice (DOJ) announced that its combined efforts with the U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG) resulted in $2.6 billion in recoveries for healthcare fraud and abuse enforcement actions in fiscal year 2017. The DOJ and HHS-OIG use multi-disciplinary teams of law enforcement agents, prosecutors, attorneys, and auditors to investigate and pursue enforcement actions for suspected healthcare fraud, waste, and abuse. The DOJ’s announcement noted that, for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4.

The DOJ and HHS-OIG noted that last year’s healthcare fraud and abuse enforcement activity focused heavily on: (1) providers operating “pill mills” out of their medical offices; (2) providers submitting false claims to Medicare for ambulance transportation services; (3) clinics submitting false claims to Medicare and Medicaid for physical and occupational therapy; (4) drug companies paying kickbacks to providers to prescribe their drugs, and pharmacies soliciting and receiving kickbacks from pharmaceutical companies for promoting their drugs; and (5) companies misrepresenting capabilities of their electronic health record software to customers.

In addition to recovering $2.6 billion, the DOJ also opened 967 new criminal healthcare fraud investigations, filed criminal charges in 439 cases involving 720 defendants, and convicted a total of 639 defendants for crimes involving healthcare fraud in fiscal year 2017. Additionally, the government’s enforcement actions resulted in a total of 3,244 individuals and entities being excluded from participating in federal health programs such as Medicare, Medicaid, and TRICARE.

The DOJ and HHS-OIG’s report noted that Medicare reviews 4 million claims per day, and that the government continues to improve its use of data analytics and surveillance to “crack down on, prevent and prosecute health care fraud.” The report also emphasized the government’s focus on curtailing the opioid epidemic by focusing on providers with “questionable prescribing patterns.” Such statements, along with the multi-billion dollar recovery and numerous criminal enforcement actions, clearly demonstrates that the federal government continues to devote significant resources to crack down on suspected fraud, waste, and abuse affecting federal health programs.

The attorneys at Chilivis Grubman represent healthcare providers of all types and sizes in connection with a wide-variety of regulatory and compliance matters, including government investigations, audits, and litigation. For any questions, or if we can assist you in connection with a healthcare regulatory or compliance issue or audit/investigation, please contact us at (404) 262-6505 or sgrubman@cglawfirm.com.