In the past two years alone, DoJ efforts under the federal False Claims Act have recovered over $4 billion that otherwise would have been lost to healthcare fraud and abuse. To further those efforts, the FY 2011 Budget for DoJ’s Health Care Fraud and Abuse Control will be increased from $211.4 million to $271.6 million, which is projected to increase healthcare recoveries an additional $2.7 billion over the next five years. This budget item is one of the only places in the entire federal government that actually contributes to the federal fisc, saving taxpayer dollars. In other words, this $60.2 million budget increase is projected to result in an over 400% return. Among other things, DoJ proposes to use the money to expand the Medicare Fraud Strike Force by adding 13 additional Health Care Fraud Prevention and Enforcement Action Teams (HEAT) in geographic areas where there are high concentrations of healthcare fraud.  According to DoJ’s Fy 2011 Budget Summary:

The Department’s efforts to combat health care fraud are funded almost exclusively through reimbursements from the Health Care Fraud and Abuse Control (HCFAC) account administered by the Department of Health and Human Services (HHS).

In FY 2010, the HCFAC account provided $211.4 million in mandatory and discretionary funding for the DOJ litigating components and the FBI which are engaged in combating health care fraud. In FY 2011, HHS’ budget contains an increase of $60.2 million for the DOJ components that receive funding from this account. These funds will be used to further the efforts of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, announced last year by the Attorney General and the HHS Secretary. Specifically, the funding will permit DOJ to expand Medicare Fraud Strike Force operations to 13 additional locations, for a total of 20 across the nation, in order to target agents and attorneys to the criminal hubs where health care fraud activities occur.

In addition, these funds will be used for civil enforcement efforts, including alleged fraud by pharmaceutical and medical device manufacturers. These anti-fraud efforts have the potential to save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs.

Read the Entire Summary Below:
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The primary weapon in DoJ’s arsenal for fighting healthcare fraud, is the qui tam provision of the federal False Claims Act, which permits whistleblowers to file suit under seal on behalf of the federal government to recover monies lost to fraud. Credible first-hand information regarding false claims submitted to Medicare or Medicaid can result in treble damages and penalties against the wrongdoers and can result in a reward of as much as 25% and under certain conditions as much as 30% of the government’s recovery. Additionally, whistleblowers are entitled under the False Claims Act to serious protection against retaliation by their employers, including reinstatement and treble lost compensation.

To report healthcare fraud or learn more about the False Claims Act, contact Frohsin & Barger.