In its Spring 2016 Semiannual Report to Congress, the Office of Inspector General (OIG) of the Department of Health and Human Services reported an increase of more than $1 billion in healthcare fraud recoveries in just the past six months. Even with the federal government’s renewed focus on healthcare fraud audits and investigations, this is a substantial increase and one that should serve as a warning to hospitals, private practitioners, hospices, compound pharmacies, and other healthcare service providers that may not be 100 percent confident in their compliance programs.
OIG is Pursuing Both Civil and Criminal Penalties
The report, which covers the period from October 1, 2015, through March 31, 2016, shows that OIG expects its total recoveries for the first half of its fiscal year to amount to $2.77 billion. This reflects an increase in settlements and fraudulent payment recoveries exceeding $1 billion over the prior reporting period.
The majority of the OIG’s recoveries roughly $2.2 billion came through civil and criminal healthcare fraud investigations (the OIG also recovered more than $500 million through audits). The Spring 2016 Semiannual Report to Congress lists 428 criminal actions against both individuals and organizations, and 383 civil actions through which it secured restitution for false claims, as well as civil monetary penalties. This means that, on average, every single day multiple healthcare providers are facing civil or criminal penalties for Medicare, Medicaid, Tricare, and other forms of healthcare fraud.
HEAT Enforcement is On the Rise as Well
Established in 2009, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a joint project of the Department of Health and Human Services and the Department of Justice that specifically targets individuals and entities suspected of healthcare fraud and abuse. HEAT is investing in new tools and resources to uncover Medicare and Medicaid fraud in particular and emphasizes quick investigations and prosecutions of those suspected of fraud and abuse.
HEAT has Strike Force operations in nine cities throughout the country, including one here in Dallas, Texas. According to the report, from October 1, 2015 through March 31, 2016, these operations filed charges in 87 separate cases resulting in over $116 million in restitution and penalties.
What Can You Do to Avoid Civil or Criminal Charges?
If your organization is facing a federal audit or investigation, then you need to take your situation extremely seriously. The government has the upper hand in these situations, and if you do not take action to protect yourself, you could end up facing insurmountable financial penalties and possibly even federal imprisonment.
At the The Criminal Defense Firm, our defense attorneys and former federal healthcare prosecutors regularly represent individuals and healthcare providers in federal audits and investigations. We can determine whether your case is civil or criminal in nature, and we can execute a proven strategy for minimizing the consequences of your situation. While we cannot guarantee results in your case, we have helped numerous clients escape federal scrutiny without any civil or criminal charges.
Schedule a Free Consultation at The Criminal Defense Firm
If you would like more information about defending against a federal healthcare audit or investigation, we encourage you to contact us for a free, confidential consultation. To speak directly with one of our senior healthcare fraud defense lawyers, call 866-603-4540 or contact us online today.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.