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Health Care Fraud Recovery Dips to $2.6 Billion: Federal Report

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Department-of-Justice (Photo : Diego M. Radzinschi/ALM)

Federal agencies recovered more than $2.6 billion in health care fraud and abuse judgments, settlements and other fees in 2017, according to a new government report.

The funds were recovered from prevention and enforcement actions against individuals and organizations engaged in alleged fraud against Medicare and Medicaid and other government programs.

(Related: Former Health Insurer General Counsel Gets 6 Months in Prison)

The U.S. Justice Department and U.S. Department of Health and Human Services targeted providers who, among other offenses, operated pill mills out of medical offices and filed false claims for ambulance services and for physical and occupational therapy. In other cases, drug companies were charged with paying kickbacks to medical providers and to pharmacies, and pharmacies were charged for soliciting and accepting kickbacks.

The figure represented a decrease from the $3.3 billion in judgments, settlements  and impositions the government said it had recovered in fiscal year 2016, but more than the $2.5 billion recovered in FY 2015. HHS officials said there was a reduction in large monetary settlements from last year because many of the “large pharmaceutical manufacturers have entered into corporate integrity agreements with the HHS office of the inspector general to establish protections against fraudulent activities.”

According to the report for 2017, the Justice Department opened 967 new criminal health care fraud investigations in which federal prosecutors filed criminal charges in 439 cases with 720 defendants, A total of 639 defendants were convicted of health care fraud-related crimes in fiscal year 2017, according to the report.

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The DOJ and HHS joint Medicare Fraud Strike Force filed 253 indictments and charges against 478 defendants, who allegedly billed federal health care programs more than $2.3 billion. The strike force obtained more than 290 guilty pleas, litigated 33 jury trials and won guilty verdicts against 40 defendants, and secured prison sentences for more than 300 defendants, with an average sentence of 50 months, according to the HHS news release about the annual report. The Justice Department also opened 948 new civil enforcement cases last year.

“Too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and exploit this generosity to line their pockets, sometimes for millions of dollars,” U.S. Attorney General Jeff Sessions said in a statement. “At the Department of Justice, we have taken historic new actions to incarcerate these criminals and recover stolen funds, including executing the largest healthcare fraud enforcement action in American history.”

Federal enforcers in July 2017 executed the single largest health care fraud enforcement operation in history. Prosecutors charged 412 defendants, including 115 doctors, nurses and other medical professionals, across the United States, for allegedly participating in health care fraud schemes involving more than $1.3 billion in false billings. More than 120 defendants were indicted for their alleged roles in prescribing and distributing opioid medications and other narcotics.

Some observers said at the time that the enforcement action indicated a shift of department priorities during the Trump administration toward illicit opioid distribution prosecution and away from white-collar fraud. Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit in August.

— Read 7 Things Trump’s New DOL Pick Knows About Benefits on ThinkAdvisor.

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