This month, the 120-page Annual Report of the Departments of Health and Human Services and Justice Health Care Fraud and Abuse Control Program FY 2020 was published.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national
Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint
direction of the Attorney General and the Secretary of the Department of Health and Human
Services (HHS), acting through the Inspector General, designed to coordinate federal, state, and
local law enforcement activities with respect to health care fraud and abuse.
In FY 2020, the Department of Justice (DOJ) opened 1,148 new criminal health care fraud
investigations. DOJ opened 1,079 new civil health care fraud investigations and had 1,498
civil health care fraud matters pending at the end of the fiscal year.
In FY 2020, investigations conducted by HHS’s Office of Inspector General (HHS-OIG) resulted
in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare
and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits
filed in federal district court, civil monetary penalties (CMP) settlements, and administrative
recoveries related to provider self-disclosure matters. HHS-OIG also excluded 2,148 individuals
and entities from participation in Medicare, Medicaid, and other federal health care programs.
During the fiscal year, the Federal Government won or negotiated more than $1.8 billion in
judgments and settlements and attained additional administrative impositions in health care fraud
cases and proceedings. Because of these efforts, as well as those of preceding years, almost $3.1
billion was returned to the Federal Government or private persons.
The Report highlights the following categories of significant criminal and civil investigations concerning health care fraud and abuse:
- Ambulance and Transportation Services
- Medical Clinics
- Drug Companies
- Durable Medical Equipment (DME)
- Electronic Health Records
- Genetic Testing/RPP Testing Paired with COVID-19 Testing
- Home Health Providers
- Hospice Care
- Hospitals and Health Systems
- Laboratories
- Medical Devices
- Nursing Homes and Facilities
- Occupational Therapy
- Pharmacies
- Physical Therapy
- Physicians and Other Health Care Practitioners
- Prescription Drugs and Opioids
- Psychiatric and Psychological Testing Services
- Substance Abuse Treatment Centers