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The Department of Health and Human Services (HHS), acting through the Office of Inspector General (OIG), and the Department of Justice (DOJ) have released the Health Care Fraud and Abuse Control Program (HCFAC) Annual Report for Fiscal Year (FY) 2017. Congress established the national HCFAC Program under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The HCFAC Program coordinates federal, state, and local law enforcement activities to combat fraud and abuse in public and private healthcare programs. The Annual Report for FY 2017 stated that the Federal Government won or negotiated over $2.4 billion in health care fraud judgments and settlements for FY 2017, in addition to other administrative impositions in health care fraud cases and proceedings. This led to $2.6 billion being returned to the Federal Government or paid to relators (whistleblowers). The Medicare Trust Funds received transfers of approximately $1.4 billion of that $2.6 billion. There was also $406.7 million of federal Medicaid money separately transferred to the U.S. Department of the Treasury as a result of HCFAC program efforts.

The OIG Office of Investigations examines fraud and abuse within HHS programs. The OIG, assisted by the DOJ and the Federal Bureau of Investigation (FBI), initiated enforcement actions to punish misuse of HHS programs. For FY 2017:

  • The OIG reported 788 criminal actions and 818 civil actions against individuals or entities that engaged in crimes related to Medicare and Medicaid;
  • The OIG also excluded 3,244 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs;
  • The DOJ opened 967 new criminal health care fraud investigations and filed criminal charges in 439 cases involving 720 defendants;
  • The DOJ also convicted 639 defendants for health care fraud-related crimes and had 948 new civil health care fraud investigations pending at the fiscal year’s end;
  • FBI investigations resulted in over 674 operational disruptions of criminal fraud organizations and dismantled more than 148 health care fraud criminal enterprises; and,
  • The return on investment for the HCFAC Program for FYs 2015-2017 was $4.20 returned for every $1.00 expended.

The full HCFAC Annual Report for FY 2017 can be seen at:

https://oig.hhs.gov/publications/docs/hcfac/FY2017-hcfac.pdf

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