Report gives glimpse of health care fraud enforcement in 2020

The 2020 annual report of the Health Care Fraud and Abuse Control Program shows that the pandemic didn’t blunt the federal government’s ability to crack down on wrongdoing.

According to the report, in fiscal year 2020 the Department of Health and Human Services (HHS) and Department of Justice (DOJ) won or negotiated more than $1.8 billion in health care fraud judgments and settlements. Those funds, as well as others from previous years, saw nearly $3.1 billion returned to the Federal Government or paid out to private individuals in 2020. Of that $3.1 billion, about $2.1 billion went to the Medicare Trust Funds in addition to the $128.2 million in federal Medicaid funds that was transferred separately due to these efforts.

The DOJ opened 1,148 new criminal health care fraud investigation in fiscal year 2020, while federal prosecutors filed criminal charges in 412 cases involving 679 defendants. That year 440 defendants were convicted of health care fraud related crimes. The DOJ also opened 1,079 new civil health care fraud investigations and there were 1,498 pending civil fraud matters at the end of the year, the report says.

The FBI’s investigations resulted in more than 407 operational disruptions of criminal fraud organizations and the hierarchy of 101 such organizations dismantled, according to the report.

HHS’ Office of Inspector General’s (HHS-OIG) investigations produced 578 criminal actions against people or entities engaged in Medicare or Medicaid crimes. It also resulted in 781 civil actions including false claims and unjust-enrichment suits filed in federal district court, civil monetary penalties settlements, and administrative recoveries, the report says.

The HHS-OIG also excluded 2,148 people and entities from participating in Medicare, Medicaid, and other federal health care programs. Some of these exclusions were based on crimes related to Medicare and Medicaid (891), or other health care programs (316), for patient abuse or neglect (230), and due to revocations of state health care license (509), according to the release.