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Posts Tagged ‘Health Care Fraud’

Whistleblower Settlements Increase Compliance Risk for Providers

Wednesday, May 16th, 2018

Recent Fraud Settlements Emphasize Risk of Whisttleblowers

Dermatology Risk Areas Fraud and AbuseOne of the reasons why compliance officers and health care attorneys read fraud settlements is to identify the issues that the government is focused on.  The cases that the government decides to pursue are very indicative of the areas of fraud enforcement that they feel are important.  These are not the only issues that should be considered, but government enforcement actions certainly tell us what types of arrangements the government considers important.

The misfortune of the defendants involved in these cases hold a potential learning experience for everyone else.  Others have an opportunity to focus on their own operations to identify whether they are at risk in any of the areas involved in these cases.

An ancillary lesson that these settlements hold is that each was initially raised by a whistleblower.  The False Claims Act gives whistleblowers a portion of the settlement in cases where the government decides to intervene.  This in effect creates a universe of potential claimants that can include almost anyone with original knowledge of the alleged practice.

Common whistleblowers include former or disgruntled employees.  It really does not matter of the employee is or was the worst employee in the world, they can still bring an action as a whistleblower.  Not only are they protected by a host of laws, they can also profit greatly if the claim is eventually decided in their favor.  Whistleblowers often receive awards in the millions of dollars.  This makes the area ripe for plaintiff’s attorneys who often take these cases on a contingency fee basis.  This makes it a relatively low-cost proposition for a whistleblower to bring a case forward, at least from the perspective of attorney fees.

Health Care Leads in Fraud Recoveries in 2017

Thursday, December 28th, 2017

fraud recovery doj report 2017Health Care Leads With $2.4 Billion Fraud Recoveries in 2017

The United States Department of Justice recently released a summary of recoveries from False Claims Act cases for Fiscal Year 2017.  The report, which was released in late December 2017, indicates that the DOJ recovered over $3.7 billion in settlements and judgments from civil cases involving fraud and false claims during 2017.

One thing is evident when examining the report.  The lion’s share of recoveries come from the health care industry.  Almost $2.5 billion of the $3.7 billion in total recoveries involved health care providers and others in the health care industry.  This is not a new trend.  Health care has led in recoveries with over $2 billion per year for the past 8 years in a row.

The department’s health care fraud program is intended to restore assets to federally funded programs, such as Medicare, Medicaid, and TRICARE.  By all reports, health care fraud and abuse recovery is big business for the Federal government.  The details vary, but reports indicate that the government receives between seven and ten times return on every dollar it spends on pursuing health care fraud and abuse cases.  Recent revisions to Federal False Claims Act penalties increased the maximum penalty per claim from $11,000 to $22,000.  This increase is likely to result in even more aggressive enforcement and an even higher percentage return on the government’s investment in this area.

The high potential financial exposure is intended to deter others from committing health care fraud.  Additionally, the high potential exposure provides an incentive for providers to put in place proactive compliance programs to help identify errors and instances of noncompliance that could eventually result in unmanageable penalties if allowed to emerge through discovery by government audits or a whistleblower complaint.  It is generally much preferable for a provider to discover and correct a problem on its own initiative rather than exposing itself to draconian penalties.

Annual Health Care Fraud and Abuse Control Program Report

Tuesday, March 11th, 2014

Record Recovery for Health Care Fraud and Abuse

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) recently released its annual Health Care Fraud and Abuse Control Program (HCFAC) report. This report indicates that in the last three years for every dollar spent on health care related fraud and abuse investigations through HCFAC and other government programs, the government recovered $8.10. This is a record high for the 17-year old program.  HCFAC focuses on eliminating fraud, waste, and abuse in the health care industry.

A few notes on the report’s numbers:shutterstock_1766714

•      The federal government recovered a record-breaking $4.3 billion in fiscal year 2013 alone.
•      Over the last five years, the federal government recovered $19.2 billion—this is more than double the previous five-year period.
•      In fiscal year 2013, the DOJ and HHS strike force team filed 137 cases, charged 345 individuals with crimes, secured 234 guilty pleas, and achieved 46 convictions.
•      Defendants sentenced in fiscal year 2013 served an average of 52 months in prison.
•      Centers for Medicare and Medicaid Services (CMS) have banned 225,000 individuals and entities from billing Medicare between March 2011 and September 2013.

Attorney General Eric Holder states that, “With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive health care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal health care programs,” said Attorney General Eric Holder.

The return on investigation investment suggests that the federal government’s interest in investigating and prosecuting health care fraud and abuse is substantial. In short, health care compliance is more important than ever.

Annual Health Care Fraud and Abuse Control Program Report

Monday, March 10th, 2014

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) recently released its annual Health Care Fraud and Abuse Control Program (HCFAC) report.  This report indicates that in the last three years for every dollar spent on health care related fraud and abuse investigations through HCFAC and other government programs, the government recovered $8.10. This ishutterstock_1766714s a record high for the 17-year old HFAC program. The HFAC program focuses on eliminating fraud, waste, and abuse in the health care industry.

A few notes on the report’s numbers:

• The federal government recovered a record-breaking $4.3 billion in fiscal year 2013 alone.
• Over the last five years, the federal government recovered $19.2 billion—this is more than double the previous five-year period.
• In fiscal year 2013, the DOJ and HHS strike force team filed 137 cases, charged 345 individuals with crimes, secured 234 guilty pleas, and achieved 46 convictions.
• Defendants sentenced in fiscal year 2013 served an average of 52 months in prison.
• Centers for Medicare and Medicaid Services (CMS) have banned 225,000 individuals and entities from billing Medicare between March 2011 and September 2013.

Attorney General Eric Holder states that, “With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive health care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal health care programs,” said Attorney General Eric Holder.

The return on investigation investment suggests that the federal government’s interest in investigating and prosecuting health care fraud and abuse is substantial. In short, health care compliance is more important than ever.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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