Fraud is an unacceptable crime in any industry. In the medical field, however, there is an especially bad taste left in the mouths of Americans who know that paying healthcare insurance premiums should never be a lost cause. After all, is there anything more important than our health? With that said, our blog has been paying close attention to incidents of medical fraud throughout our country over the past few weeks.
This week, we’re happy to say that all of the news surrounding fraud in the medical world isn’t bad. A few weeks ago, it was reported that the Department of Health and Human Services has actually improved upon its ability to recover fraudulent payments and settlements in the first half of fiscal year 2016. According by Emily Mongan on McKnights.com, more than a billion dollars has been recovered this year, as reported by the Office of Inspector General.
In the OIG’s Semiannual Report To Congress, published on May 31st, it was revealed that the total amount of expected recoveries reported between October 1, 2015 and March 31, 2016 is to the tune of $2.77 billion. “That includes roughly $555 million in recoveries found through audits and $2.2 billion through investigations,” informs Mongan. In the report, Inspector General, Daniel R. Levinson expands on the OIG’s commitment to reduce healthcare fraud.
“OIG advances its core mission of protecting the integrity of HHS (The Department of Health And Human Services) programs and the people they serve by working to prevent and detect fraud, waste, and abuse,” he informs, “When misconduct is identified, OIG takes appropriate enforcement action or makes recommendations to improve Department programs and operations. One of the ways in which OIG helps to prevent fraud, waste, and abuse is by providing guidance that supports the health care industry’s compliance efforts.”
The OIG report found 428 criminal actions reported against people who committed crimes against HHS programs. In addition, it was found that there were 383 civil actions such as false claims, administrative recoveries and civil monetary penalties. “The HHS’ Health Care Fraud Strike Force teams brought charges against 87 individuals or entities, 100 criminal actions and $116.8 million in recoveries through investigations,” reports Monagan, “The OIG also reported 1,662 individuals and entities barred from participating in federal healthcare programs during the first half of FY 2016.”
At Allegiant Experts, we’re quite proud of the work performed by the Office of Inspector General. Not only is a lot of work being done to recover money lost on fraudulent claims, but regulations are being put in place to prevent them from happening in the future. In the OIG report, Levinson reveals that reminders about policy as well as recommendations to prevent problematic recurrences are provided to healthcare providers.
“For this reporting period, OIG issued a policy reminder about information blocking and the anti-kickback statute and a policy statement regarding self-administered Medicare drugs dispensed in outpatient settings,” he writes, “Another way that we strive to prevent problems is by making recommendations, that, if implemented, would address vulnerabilities and prevent recurrence of the identified problem.”
The importance of minimizing fraud in the healthcare industry cannot be overstated. And the team, here at Allegiant Experts, is certainly committed to doing our part! For information about how our clinical experts can help your legal battle against those who commit fraud, please don’t hesitate to contact us at 407-217-5831.
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