Author: Dee L. Mahoney
In May 2009, the Department of Justice (DOJ) and Human Health and Human Services (HHS) announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). As part of a larger effort by the Obama administration, HEAT and its parent organizations have made the fight against Medicare fraud a Cabinet-level priority. The purpose of HEAT is to build upon existing partnerships between the DOJ and HHS and gather resources across the government to help prevent waste, fraud and abuse in the Medicare and Medicaid programs.
Initiatives like the HEAT task force are proving effective. In the Fiscal Year of 2010, the government recovered more than $4 billion in taxpayer dollars. This is the highest annual amount ever recovered from individuals who attempted healthcare fraud against taxpayers. Many of these recoveries were made possible thanks to qui tam, or whistleblower lawsuits alleging violations of the False Claims Act.
So, how many healthcare fraud investigations (pdf) are currently underway? As of the beginning of 2011, there were 885 healthcare qui tam cases under investigation. Of those 885 qui tam cases, 180 allege that pharmaceutical and device manufacturers are committing fraud in connection with the pricing and marketing of their products. The majority of these investigations are under seal with no decision yet as to whether federal authorities will prosecute.
The scrutiny on the pharmaceutical and medical device industries does not show any signs of letting up. Biopharmaceutical and device manufactures must ensure that they not only have policies and procedures in place that govern lawful promotion, but must also conduct effective training that will bridge the gap between written policies and procedures and compliant field conduct.
- CareSource to Pay $26 Million to Resolve False Claims Act Lawsuit (prweb.com)
- HHS Collects Record Amount in Fraud Repayments (abcnews.go.com)
- Government Recovers $4 Billion from Health Care Fraud Cases (dailyfinance.com)
- “Press Release: Health Care Fraud Prevention and Enforcement Efforts Recover Record $4 Billion; New Affordable Care Act Tools Will Help Fight Fraud” and related posts (mainjustice.com)