This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022. The Report effectively serves as a health care fraud and abuse enforcement “highlight reel” ahead of the yearly push to get additional funding from Federal government appropriators. For that reason, and similar to the HHS Office of Inspector General’s (OIG) recently issued Top Management and Performance Challenges document (Garfunkel Wild Alert) , the Report typically flies under the provider community’s radar. Providers, however, should take note because the document gives critical insight into DOJ and OIG enforcement priorities, and the OIG’s use of data analytics, among other issues.
In Fiscal Year 2022, the DOJ filed criminal charges in over 419 cases involving at least 680 defendants, and more than 477 defendants were convicted of health care fraud-related crimes. The DOJ also opened more than 774 new civil health care fraud investigations and had more than 1,200 such matters pending at the end of the year. OIG investigations resulted in 661 criminal actions against individuals or entities that alleged to have engaged in Medicare and Medicaid-related crimes, 726 civil actions, and over 2,300 exclusions. Monetary recoveries from these combined actions exceeded $1.7 billion. Underlying these numbers is an important reminder to providers about the scope and breadth of these enforcement actions which touched nearly all types of providers including:
- Physicians and their practice groups;
- Clinics, hospitals, and health care systems;
- Pharmacies, drug companies, device companies and manufacturers, and durable medical equipment suppliers;
- Laboratories and diagnostic testing facilities; and
- Ambulance suppliers, home health and hospice care providers, and nursing homes and facilities.
In addition, the Report highlighted other growing areas of concern for the DOJ and OIG including:
- COVID-19-related fraud;
- Physical therapy;
- Psychiatric and psychological testing and services;
- Prescription drugs, opioids, and substance use treatment centers;
- Telemedicine; and
- Genetic testing and respiratory pathogen panel testing.
It is clear from the report that both the DOJ and OIG have, and will remain, busy in the health care fraud and abuse enforcement arena. Therefore, providers and other relevant stakeholders operating in these “high-risk” areas must remain vigilant and understand their respective risks. A copy of the complete HCFAC Report can be found at: https://oig.hhs.gov/publications/docs/hcfac/FY2022-hcfac.pdf.
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].