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Photo: Blanchi Costela/Getty Images
The federal government recovered more than $5 billion in healthcare fraud settlements and judgments in fiscal year 2021, according to the joint annual government Health Care Fraud and Abuse Control Program Annual Report from the of the Departments of Justice and Health and Human Services.
It was the largest amount of money ever recovered by the HHS and DOJ’s fraud and abuse enforcement program.
The DOJ opened 831 new criminal healthcare fraud investigations in FY 2021, with judgements and settlements returning almost $1.9 billion to the federal government or to private citizens through payments.
Of the nearly $2 billion, $1.2 billion went into the Medicare trust fund, while nearly $98.6 million was transferred to the CMS, the report stated.
Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, with a total of 312 defendants convinced in FY 2021 of healthcare fraud-related crimes.
WHY IT MATTERS:
The Health Care Fraud and Abuse Control Program was established as part of HIPAA with the aim to help the DOJ and HHS coordinate efforts to uncover and stamp out fraud and abuse in the healthcare industry.
In August, Sutter Health agreed to pay the federal government $90 million to settle allegations that it submitted false information about its Medicare Advantage beneficiaries.
In September 2021, Independent Health, DxID allegedly inflated MA reimbursement through unsupported diagnosis codes in violation of the False Claims Act.
At the start of 2021, EHR vendor athenahealth agreed to pay $18.25 million to resolve False Claims Act violation allegations after the DOJ alleged the company had paid illegal kickbacks to generate sales of its EHR product.
THE LARGER TREND:
In May, the American Hospital Association sent a letter to the DOJ asking it to investigate routine denials from major health insurance companies.
The organization recommended that it establish a task force “to conduct False Claims Act investigations into commercial health insurance companies that are found to routinely deny patients access to services and deny payments to healthcare providers.”
In an effort to prosecute fraud perpetrated during the pandemic, the DOJ in March named Associate Deputy Attorney General Kevin Chambers as director for COVID-19 Fraud Enforcement.
Chambers will lead Justice Department efforts that to date have resulted in criminal charges against more than 1,000 defendants with alleged losses exceeding $1.1 billion.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
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