HHS OIG Announces Collection of Almost $2 Billion in Healthcare Fraud in 2021

 Posted on July 14, 2022 in Medical License Defense

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued the latest edition of the Health Care Fraud and Abuse Control Program (HCFAC) Annual Report. The report details the collection of just under $1.9 billion in healthcare fraud settlements and judgments in fiscal year 2021. Funds were returned to the Medicare Trust Funds and also to other federal agencies. Per the HCFAC, the federal government was able to recoup more than $5 billion in healthcare fraud.

Healthcare Fraud Charges

The U.S. Department of Justice (DOJ) initiated more than 800 new criminal healthcare fraud investigations last year. Of those investigations, federal prosecutors filed criminal charges against 741 defendants. More than 300 of those defendants have already been convicted of healthcare fraud-related offenses.

According to the report, the COVID-19 pandemic contributed to an increase in the number of healthcare fraud cases that involved unnecessary lab testing, unnecessary services, and fraudulently obtaining pandemic healthcare relief funds.

Other frequent types of healthcare fraud cases involved:

• Ambulance and transportation

• Diagnostic testing

• Genetic testing

• Home healthcare providers

• Managed care

• Medical devices

• Medical equipment

Which Agencies Received Reimbursement?

The report also outlined which government agencies received the collected funds:

• The Department of the Treasury received $656 million, including asset forfeitures, civil monetary penalties, criminal fines, penalties, and damages.

• The Centers for Medicare & Medicaid Services (CMS) received $551 million. More than $68 million was collected due to Medicare disallowances. These funds were discovered through audits conducted by both HHS and OIG. CMS also received $482 million in compensatory damages and restitution, as well as $395 million for the federal share of Medicaid and recovered Medicaid disallowances.

• DOJ/Drug Enforcement Administration, HHS/OIG, Office of Personnel Management, TRICARE, and the U.S. Postal Service received a total of $63 million.

• More than $193 million went to private individuals under the whistleblower provision of the False Claims Act.

In addition to the billions of dollars, approximately 1,700 entities and/or individuals were excluded from participating in Medicaid, Medicare, and other federal healthcare programs. This exclusion was due to:

• Criminal convictions for crimes related to Medicaid or Medicare (569 excluded)

• State agency medical license revocation (536 excluded)

• Criminal convictions for crimes related to other healthcare programs (267 excluded)

• Beneficiary abuse or neglect (145 excluded)

Contact an Illinois Medical License Defense Attorney

Accusations of healthcare fraud are serious. Not only can these allegations lead to civil charges and loss of your medical license, but they can also result in criminal charges and loss of freedom. If you have been notified that you are being investigated, do not delay in contacting an Illinois healthcare fraud lawyer. Call The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to schedule a free and confidential consultation.

Sources:

https://oig.hhs.gov/publications/docs/hcfac/FY2021-hcfac.pdf