2011—The Year In Review: Trends in Health Care Enforcement The First in a Continuing Series

Since President Obama formed the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) in May 2009, combating health care fraud has been a federal “cabinet-level priority.”  Statistics from fiscal year 2011 (“2011”) demonstrate the impact of the federal government’s investment of substantial resources in health care enforcement. Last year, federal and state enforcement agencies filed a record number of criminal and civil cases and recovered record-breaking financial settlements in the health care fraud arena.

According to available data, the Department of Justice (“DOJ”) initiated 1,235 new health care fraud prosecutions in 2011—an increase of 68.9% over fiscal year 2010 (“2010”), and recovered $2.4 billion in health care settlements and judgments under the federal False Claims Act (“FCA”). In addition, the Department of Health and Human Services’(“HHS”) Office of Inspector General (“OIG”) reported that 614 criminal and 381 civil actions had been brought against individuals and entities allegedly involved in health-care-related offenses. As a result, HHS obtained $3.6 billion in investigative receivables and $947 million in non-HHS investigative receivables, including receivables relating to States’ share of Medicaid restitution.

The general enforcement trends from last year include...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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