We have occasionally looked at the ever-increasing fraud prevention focus of the current administration, such as in this October report on an alleged $430 million Medicare fraud scheme. In its Fall 2012 Semiannual Report to Congress, the Department of Health & Human Services (HHS) Office of Inspector General (OIG) said such efforts to prevent fraud are likely to result in the recovery of about $6.9 billion from audits and investigations for FY 2012.
The $6.9 billion in expected recoveries comes from more than $900 million in audit receivables and $6 billion in investigative receivables.
OIG reported it excluded more than 3,000 individuals and entities from participation in federal healthcare programs in FY 2012; reported 778 criminal actions against individuals or entities that engaged in crimes against HHS programs; and reported 367 civil actions, which include false claims and unjust enrichment lawsuits filed in federal district court, civil monetary penalties settlements and administrative recoveries related to provider self-disclosure matters.
Highlights of OIG accomplishments for FY 2012 include the efforts of the Medicare Fraud Strike Force, which charged, in May, 107 individuals in seven cities for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing and GlaxoSmithKline agreeing to pay $3 billion to resolve violations regarding its marketing and promotion practices associated with several drugs.
Fighting Medicare fraud has been a priority for President Obama. With his reelection, the prevention of healthcare fraud is likely to remain a focus over the next four years, of which providers and investors should be constantly aware.