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Feb 25

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Federal health care fraud enforcement efforts recover record amounts

U.S. Department of Health and Human Services (HHS) released a required annual Health Care Fraud and Abuse Control Program report.  The report showed that the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in fiscal year 2010. This is the highest annual amount ever recovered.

Interestingly, the report shows that $306.6 million was paid to qui tam plaintiffs who filed suits on behalf of the federal government under the qui tam provisions of the False Claims Act.  By comparison, the fiscal 2009 payment total for qui tam plaintiffs was 48.3 million, or 84% less.  This would indicate that the record results occurred at least in part because of private efforts, and not the efforts bragged about by HHS and DOJ officials. 

In 2008, HHS’ Centers for Medicare & Medicaid Services (CMS) began the process of consolidating all Program Safeguard Contractor (PSC) and Medicare Prescription Drug Integrity Contractor (MEDIC) contracts into Zone Program Integrity Contractors or (ZPIC) contracts.  The ZPIC audit program is performed by independent contractors who perform audits on behalf of the federal government. 

We describe the statistically-based audit approach and additional details of the report in this more complete article.  Whether because of qui tam suits, ZPIC audits, or other increased enforcement of the Obama administration, healthcare providers should expect increased scrutiny of their billings.

About the author

David Nolte

I am a founding principal of Fulcrum Inquiry, an accounting and economic consulting firm that performs damage analysis for commercial litigation, forensic accountings, financial investigations, and business valuations. I am a Certified Public Accountant (CPA) and an Accredited Senior Appraiser (ASA), as well as having other professional credentials. I regularly serve as an expert witness involving damages measurement. My litigation-oriented resume is on Fulcrum's website.

Permanent link to this article: http://betweenthenumbers.net/2011/02/federal-health-care-fraud-enforcement-efforts-recover-record-amounts/

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