DOJ and HHS Release Healthcare Fraud and Abuse Program Fiscal Year 2021 Report | King and Spalding

Last week, the DOJ and HHS-OIG released their annual report regarding the Healthcare Fraud and Abuse (HFAC) Program (the Report). The report summarizes DOJ and HHS enforcement activity and indicates that in fiscal year 2021, the federal government secured or negotiated more than $5 billion in healthcare fraud judgments and settlements. healthcare, in addition to other healthcare administrative impositions in healthcare fraud proceedings.

These efforts, along with efforts from previous years, resulted in approximately $1.9 billion being returned to the federal government or paid out to individuals in fiscal year 2021. Of that $1.9 billion, the Medicare Trust Fund received about $1.2 billion.
Regarding enforcement actions, the DOJ opened 831 new criminal health care fraud investigations, a decrease from the 1,148 new criminal health care fraud investigations opened in the past year. fiscal year 2020, as summarized in the HCFAC report for fiscal year 2020, available here. Additionally, 312 defendants were convicted of crimes related to healthcare fraud in fiscal year 2021, a decrease from 440 in fiscal year 2020. The DOJ also opened 805 new civil healthcare fraud investigations in fiscal year 2021, a decrease from 1,079 new civil investigations in fiscal year 2020.

HHS-OIG also conducted investigations in fiscal year 2021, which resulted in 504 criminal actions against individuals or entities who engaged in Medicare and Medicaid-related crimes, and 669 civil actions, which include misrepresentations and unjust enrichment lawsuits filed in federal district court. , and civil monetary penalties. This is a decrease from 578 criminal actions and 781 civil actions in fiscal year 2020. HHS-OIG also excluded 1,689 individuals and entities from participation in federal health care programs in 2021, a decrease from 2,148 in 2020.

The report also notes that the return on investment for the HCFAC program over the past three years (2019-2021) was $4.00 returned for every $1.00 spent, based on actual recoveries and recoveries.

The report further highlights significant criminal and civil investigations in the healthcare industry, including with respect to pharmaceutical companies, durable medical equipment, electronic health records, genetic testing and COVID-19. , home health, palliative care, hospitals, laboratory tests, nursing homes, pharmacies, doctors, prescription drugs and opioids, and psychiatric and psychological testing services. The report further summarizes HHS-OIG activities and accomplishments, including enforcement actions, audits/assessments, and a focus on data analytics. The report also discusses the activities of the Centers for Medicare and Medicaid Services, including its use of predictive analytics technology to prevent abusive payments, and its medical examination activities. In addition, efforts related to the Food and Drug Administration’s pharmaceutical fraud program, the Department of Justice’s civil and criminal divisions, and the Federal Bureau of Investigation are also included in the report.

The HCFAC report for the 2021 financial year is available here.

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