HHS, DOJ Release Fraud and Abuse Report

July 23, 2020 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Home Health | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth

The U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) have released the 2019 annual report for their Health Care Fraud and Abuse Control Program. The government recovered almost $3.6 billion, of which about $2.5 billion was returned to the Medicare trust fund. The recoveries included judgments and settlements from fraud causes brought in 2019 and in prior years.

In 2019, the DOJ opened 1,060 new criminal healthcare fraud investigations, which led to federal prosecutors opening 485 cases and filing charges against 814 defendants. The DOJ also opened 1,112 new civil healthcare fraud investigations. In addition, Medicare and Medicaid fraud investigations by HHS’s Office of Inspector General resulted in 747 criminal actions and 684 civil actions against individuals and entities. In 2019, HHS also excluded 2,640 individuals from participation in the Medicare and Medicaid programs.

HHS and DOJ Strike Force teams generally include agents from the Federal Bureau of Investigation (which also investigates healthcare fraud separately), U.S. Drug Enforcement Agency, and state regulatory bodies. Favorite targets in 2019 included so-called pill mills and fraudulent genetic testing companies, as discussed here, but the annual report summarizes cases in a wide range of areas.

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