By Stephanie Gallagher, JD
stephanie.gallagher@corporatecompliance.org
The Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued a press release today, announcing over $27.8 billion in returned Medicare funds from a joint effort to combat health care fraud. The departments recovered over $3.3 billion in 2014, from individuals and companies that attempted to defraud federal programs. This joint effort has resulted in the highest ROI in the Health Care Fraud and Abuse Control (HCFAC) program since its inception in 1977, at $7.70 recovered for every dollar spent on health care fraud investigation.
The administration is moving towards a two-pronged strategy to combat fraud and abuse, emphasizing the implementation of programs that move away from the “pay and chase” model to the prevention of health care fraud and abuse in the first place. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is changing how it fights health care fraud, and is implementing real-time investigation data analysis as opposed to a prolonged subpoena and account analysis, which will significantly reduce the period of time between the fraud identification, and arrest and prosecution.
In addition to relying on prosecution under the False Claims Act, increased funding from the administration and Congress will allow for the growth of the Medicare Strike Force by expanding into nine additional geographic territories.
CMS is also adopting a number of preventative measures to combat fraud and abuse, including the implementation of new technology also used by credit card companies to monitor and identify suspicious billing patterns, which will trigger swift action to prevent payment of fraudulent claims.
The significance of this news for the healthcare compliance community cannot be underestimated. With the implementation of programs designed to swiftly identify and prosecute healthcare fraud and abuse, adequate compliance programs and policies are more important than ever. Prevention of these events is crucial, and implementing a solid compliance program is the key to avoiding issues and allegations of healthcare fraud and abuse. The implementation of an effective compliance program will pay dividends in the long run, especially given the swift approach the DOJ and HHS are taking with potential fraud claims. The full press release is available here.