Last year, after investigating healthcare fraud, nearly $3.1 billion was returned to the federal government or paid to private individuals. According to a new report.
The report was issued by the Ministry of Health and Human Services and the Ministry of Justice this month, detailing the Healthcare Fraud and Abuse Control ProgramThe plan was formulated by the Health Insurance Portability and Accountability Act of 1996 and is jointly directed by the Attorney General and the Secretary of HHS.
The Department of Justice initiated 1,148 new criminal healthcare fraud investigations in fiscal year 2020, and federal prosecutors filed criminal charges in 412 cases involving 679 defendants.
During the year, a total of 440 defendants were convicted of crimes related to health care fraud.
In addition, the Ministry of Justice initiated 1,079 new civil fraud investigations last year. By the end of the year, the department had 1,498 outstanding civil fraud cases, including cases before 2020.
Investigations conducted by the HHS Inspector General’s Office resulted in 578 criminal prosecutions against individuals or entities engaged in crimes related to Medicare and Medicaid, and 781 civil lawsuits, including false claims and unjust enrichment lawsuits filed in federal district courts .
The federal government won or negotiated more than $1.8 billion in judgments and settlements in fiscal year 2020. As a result of these efforts and those of previous years, nearly US$3.1 billion was returned to the government or private individuals.
Of this $3.1 billion, the Medicare Trust Fund received approximately $2.1 billion in transfers. Another $128.2 million in federal medical assistance funds was transferred to the national treasury.
Specifically, regarding violations of the False Declaration Act and the Anti-Kickback Act, OIG recovered more than US$8.2 million in affirmative enforcement actions.
These included a large-scale national withdrawal in September last year, which resulted in 345 people being accused of submitting more than $6 billion in false claims to federal health care programs and private insurance companies. Fraudulent claims include more than US$4.5 billion related to telemedicine and more than US$845 million related to drug abuse treatment facilities and illegal opioid distribution programs nationwide.
The report also highlighted the first rebate action for EHR developers to collect payments from pharmaceutical companies.
In January 2020, EHR developer Practice Fusion agreed to pay US$145 million to settle criminal and civil liabilities related to its solicitation and collection of kickbacks from a large opioid company. According to the report, Practice Fusion allegedly implemented a clinical decision support alert, aimed at increasing the prescription of pharmaceutical company products in exchange for payment.
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