Health and Human Services Office of Insepector General Semi-Annual Fraud Report Highlights Federal Government Enforcement Activities
There continues to be significant media attention on health care privacy and data breaches, the opioid crisis, Medicaid funding and expansion efforts, telemedicine, and mergers and acquisitions affecting the health care delivery system (and appropriately so). Fraud and abuse prevention, detection and prosecution remains an important part of the federal and state governments’ enforcement efforts. The HHS Office of Inspector General (OIG) recently released its Spring semiannual report highlighting OIG initiatives and activities for the six-month period ending March 31, 2018 (the 2018 SA Report).
The 110-page 2018 SA Report highlights oversight activities by the OIG with respect to the Centers for Medicare and Medicaid Services (CMS) and various legal and investigative activities relating to Medicare and Medicaid. The 2018 SA Report notes that OIG has investigated or taken actions against participants in many different sectors of the health care delivery system. The OIG hotline for citizens to ask questions about or report suspicious fraudulent activity received almost 54,00 calls during the six-month period and almost 7,000 tips were referred for some type of action.
The OIG’s strategic plan for 2014-2018 focuses on four initiatives: (1) fight fraud, waste and abuse; (2) promote quality, safety and value; (3) secure HHS programs’ future; and (4) advance excellence and innovation.
With respect to the fraud and abuse initiative, the 2018 SA Report notes the following for the six-month reporting period:
• expected investigative recoveries of $1.46 billion (yes, that is billion, not million);
• criminal actions against more than 400 individuals and entities;
• exclusion of almost 1,600 individuals and entities from participation in the federal health programs; and
• civil actions against almost 350 individuals and entities.
The following are among the highlights noted by the 2018 SA Report for the six-month reporting period:
• a Miami home health agency sentenced to more than six years and $45 million in restitution;
• a drug manufacturer agreed to pay $210 million and enter into a five-year corporate integrity agreement (CIA) to resolve kickback allegations;
• a Kentucky pharmacist convicted on 71 counts and excluded for 50 years from Medicare and Medicaid for illegally dispensing controlled substances; and
• the nation’s largest for-profit hospice provider agreed to a $75.5 million payment and a five-year CIA to resolve allegations of submitting false claims to Medicare.
The 2018 SA Report is a reminder that fraud and abuse and other inappropriate conduct remain prevalent in the health care delivery system and a priority for enforcement authorities. Compliance with the Federal Anti-Kickback Statute, the Federal Stark Law, the Federal False Claims Act and state-based fraud and abuse laws should remain a priority for all health care providers. Developing and maintaining an effective compliance plan and promoting transparency in operations will help foster a culture of compliance with relevant fraud and abuse laws.
Saul Ewing Arnstein & Lehr’s health care practice has experience counseling all types of participants in the health care delivery system to ensure proactive compliance with the federal and state fraud and abuse laws and investigating and providing advice in the event of a government investigation or enforcement action.