The Department of Health and Human Services (HHS) and Department of Justice (DOJ) recently released the Health Care Fraud and Abuse Control Program Annual Report for FY 2007. According to the Annual Report, the federal government won or negotiated approximately $1.8 billion in judgments and settlements, and attained additional administrative impositions, in health care fraud cases and proceedings during fiscal year 2007. During fiscal year 2007, the Medicare Trust Fund also received transfers of approximately $797 million as a result of these efforts including those of preceding years. Further, the Annual Report indicates that during 2007 the following activity occurred:

  • U.S. Attorneys’ Offices opened 878 new criminal health care fraud investigations involving 1,548 potential Defendants.
  • Federal prosecutors had 1,612 health care fraud criminal investigations pending, involving 2,603 potential defendants, and filed criminal charges in 434 cases involving 786 Defendants.
  • A total of 560 Defendants were convicted for health care fraud related crimes.
  • The Justice Department opened 776 new civil health care fraud investigations, had 743 civil health care fraud investigations pending, and opened 218 new civil health care fraud cases.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established the Health Care Fraud and Abuse Control Program (HCFAC). Under the joint direction of the Attorney General and HHS acting through HHS’ Office of Inspector General, the HCFAC program is designed to coordinate Federal, State and local law enforcement activities concerning health care fraud and abuse. HIPAA requires that HHS and DOJ detail the amounts deposited and appropriated to the Medicare Trust Fund and the source of such deposits in the Annual Report.

Source: Medicare Update

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