The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently announced that it expects to recover an estimated $3.8 billion in overall recoveries for the first half of fiscal year 2013. This report covers October 1, 2012 through March 31, 2013.
The OIG’s semiannual report is released every 6 months to keep Congress and the HHS Secretary Kathleen Sebelius informed of the OIG’s important findings, recommendations, and activities. In connection with its Medicare and Medicaid investigations, audits, and reviews, the OIG anticipates $521 million in audit receivables and $3.28 billion in investigative receivables.
In the report’s introductory message, Inspector General Daniel R. Levinson attributed the department’s success to the OIG’s cooperative activities and effective partnerships with organizations such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The OIG featured the following items in its semiannual report:
• 1,661 individuals and entities were excluded from participation in Federal healthcare programs
• 484 criminal actions and 240 civil actions against individuals and entities responsible for crimes against HHS programs and civil actions such as false claims and unjust enrichment lawsuits filed in Federal district court, civil monetary penalties (CMP) settlements, administrative recoveries related to provider self-disclosure matters
• The HEAT Medicaid Fraud Strike Force teams’ investigations “led to charges against 91 individuals, including alleged participation in Medicare fraud schemes involving approximately $494.2 million in false billing”
• Two pharmaceutical companies, Abbott Laboratories and Amgen, Inc., agreed to pay $1.5 billion and $762 million, respectively, to resolve criminal and civil charges including False Claims Act violations and illegal kickbacks
Related to Medicare and Medicaid fraud, the OIG reported that one of the most common types of fraud involved filing false claims for reimbursement. This report should encourage providers to ensure that they are compliant in all aspects of fraud and abuse laws.
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