Friday, October 31, 2003

Follow the money
with Corrine Parver

Q: Why is the OIG so intent on routing out health care fraud and abuse?

A. Follow the money! In addition to its health information privacy component, HIPAA also established a national Health Care Fraud and Abuse Control Program, under the joint direction of the Department of Justice and HHS, acting through its OIG. This program is designed to coordinate federal, state and local law enforcement activities with respect to health care fraud and abuse. Now in its sixth year, the program’s continued success is impressive: In 2002, the federal government won or negotiated more than $1.8 billion in judgments, settlements, and administrative impositions in health care fraud cases and proceedings and, as a result of these activities, collected over $1.6 billion, of which approximately $1.4 billion was returned to the Medicare Trust Fund. An additional $59 million was recovered as the federal share of Medicaid restitution, the largest return to the government since the inception of the program.

Further, federal prosecutors filed 361 criminal indictments in health care fraud cases in 2002. Some 480 defendants were convicted for health care fraud related crimes during the year. There were also 1,529 civil matters pending, and 221 civil cases filed in 2002. HHS excluded 3,448 individuals and entities from participating in the Medicare and Medicaid programs, or other federally sponsored health care programs, most as a result of convictions for crimes relating to Medicare or Medicaid, for patient abuse or neglect, or as a result of licensure revocations.

-  Corrine Parver is a partner with Dickstein Shapiro et al: 202-775-4728 or