Last week, DOJ and HHS-OIG published its annual report regarding the Healthcare Fraud and Abuse Control (HFAC) Program (the Report). The Report summarizes the enforcement activity of DOJ and HHS and states that during Fiscal Year (FY) 2021, the Federal Government won or negotiated more than $5 billion in healthcare fraud judgments and settlements in addition to other healthcare administrative impositions in healthcare fraud proceedings.

These efforts, along with efforts in prior years, resulted in approximately $1.9 billion being returned to the Federal Government or paid to private persons in FY 2021. Of the $1.9 billion, the Medicare Trust Fund received approximately $1.2 billion.
With respect to enforcement actions, DOJ opened 831 new criminal healthcare fraud investigations, a decrease from the 1148 new criminal healthcare fraud investigations opened in FY 2020 as summarized in the FY 2020 HCFAC Report, available here. In addition, 312 defendants were convicted of crimes relating to healthcare fraud in FY 2021, a decrease from 440 in FY 2020. DOJ also opened 805 new civil healthcare fraud investigations in FY 2021, a decrease from 1079 new civil investigations in FY 2020.

HHS-OIG conducted investigations in FY 2021 as well, which resulted in 504 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 669 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, and civil monetary penalty settlements. This was a decrease from the 578 criminal actions and 781 civil actions in FY 2020. HHS-OIG also excluded 1,689 individuals and entities from participation in federal healthcare 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 last three years (2019-2021) was $4.00 returned for every $1.00 expended, based on actual recoveries and collections.

The Report further highlights significant criminal and civil investigations across the healthcare industry, including with respect to drug companies, durable medical equipment, electronic health records, genetic and COVID-19 testing, home health, hospice, hospitals, lab testing, nursing homes, pharmacies, physicians, prescription drugs and opioids, and psychiatric and psychological testing services. The Report further summarizes activities and accomplishments of the HHS-OIG including enforcements actions, audits/evaluations and its focus on data analytics. The Report also addresses activities of the Centers for Medicare and Medicaid Services, including its use of predictive analytics technology to prevent improper payments, and its medical review activities. In addition, efforts relating to the Food and Drug Administration Pharmaceutical Fraud Program, Department of Justice civil and criminal divisions and Federal Bureau of Investigation are also included in the report.

The FY 2021 HCFAC Report is available here.