Thursday, June 11, 2009

New Federal Health Care Task Force Formed By HHS And DOJ

The Washington Post reported that on May 20, 2009, two federal government agencies (Department of Justice and Health and Human Services) launched a high-level task force to use technology to help detect and prevent health-care fraud. This task force will be called the Health Care Fraud Prevention and Enforcement Action Team and will be composed of senior-level officials at the Justice Department and HHS. The group will use electronic claims data, as well as the threat of federal prosecution, to look for unusual billing problems.

HHS Secretary Kathleen Sebelius also directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where "erratic" billing data suggest high levels of fraud, waste and abuse in Medicare and Medicaid programs.

The announcement comes a week after the trustees who monitor Medicare's finances predicted that the trust fund that pays hospital bills for elderly patients will be depleted by 2017, a year earlier than previously expected. The federal budget deficit and Medicare's eroding financial stability increases the pressure on authorities to crack down on fraud -- civil and criminal.

The largest sums by far recovered by the federal government in recent years have come not through criminal cases but through Justice Department intervention in civil qui tam (whistleblower) lawsuits. Many of these qui tam cases were filed under the False Claims Act against pharmaceutical companies.

For the Washington Post article, go to:

Attorney Comment: The electronic monitoring of billing and increased federal pressure makes proper billing and compliance plans more important than ever. There will be increased audits for recovery and more aggressive stances by the federal government.

Any questions or comments should be directed to: Tracy Green is a principal at Green and Associates, Attorneys at Law, Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers.


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