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Understanding and Avoiding Health Care Fraud Enforcement
In March 2015, the U.S. Departments of Justice (DOJ) and Health and Human Services (HHS) released their annual joint report to Congress on the Health Care Fraud and Abuse Control Program (HCFAC) detailing monetary recoveries, return on investment and enforcement actions for fiscal year (FY) 2014, which ended on Sept. 30, 2014.
This report sheds light on the enforcement efforts both departments have undertaken in the previous year, as well as providing a glimpse into potential enforcement focus in the coming years. By reviewing past enforcement efforts, counsel can glean information about whether their industries, companies or practices are likely to be the subject of upcoming investigations.
According to the report, since its inception in 1997, the HCFAC program has returned over $27.8 billion to the Medicare Trust Funds. This year's report shows FY 2014 recoveries totaled over $3.3 billion, almost a billion dollars less than recoveries the previous year. Although the report suggests that the difference resulted from sequestration of mandatory funding in 2014, the decrease in recoveries is more likely the product of natural fluctuations in timing of final resolution of enforcement actions.
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