OIG Medicare Medicaid Fraud Investigations – Enforcement Fines

Author: Amy Cheatham – Owner

The number of investigations, convictions and fines collected by the Department of Health and Human Services Office of Inspector General along with state and federal law enforcement has continued to steadily increase year after year. The pressure is increasing on healthcare compliance departments to ensure claims to Medicare or Medicaid do not include services provided in part or in whole by an excluded individual or vendor. SureCheckUSA’s service provides automated monthly checks of federal and state exclusion and sanction data sources such as LEIE, SAM, EPLS, GSA, OFAC, FDA, Medicare Opt Out, SSA Death Master File and available state lists. SureCheckUSA’s service provides inexpensive way for a healthcare facility to show due diligence in properly searching these lists on a monthly basis. Additionally, our experienced staff perform all necessary resolutions of search results saving your staff time.

Call us today at 217-321-2470 or send an email to infosc@surecheckusa.com!

2020 National Health Care Fraud and Opioid Takedown

The Justice Department’s Criminal Division, the FBI’s Criminal Investigative Division, the Department of Health and Human Services Office of Inspector General (HHS-OIG) and the Drug Enforcement Administration (DEA) participated in a historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.

These defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.

2018 National Health Care Fraud Takedown

The Department of Health and Human Services Office of Inspector General, along with our state and federal law enforcement partners, participated in the largest health care fraud takedown in history in June 2018. More than 600 defendants in 58 federal districts were charged with participating in fraud schemes involving about $2 billion in losses to Medicare and Medicaid. Since the last takedown, OIG also issued exclusion notices to 587 doctors, nurses, and other providers based on conduct related to opioid diversion and abuse. These enforcement actions protect Medicare and Medicaid and deter fraud — sending a strong signal that theft from these taxpayer-funded programs will not be tolerated. The money taxpayers spend fighting fraud is an excellent investment: For every $1 spent on health care-related fraud and abuse investigations in the last 3 years, more than $4 has been recovered.

2017 National Health Care Fraud Takedown

The Department of Health and Human Services Office of Inspector General, along with our state and federal law enforcement partners, participated in the largest health care fraud takedown in history in July 2017. More than 400 defendants in 41 federal districts were charged with participating in fraud schemes involving about $1.3 billion in false billings to Medicare and Medicaid. OIG also issued exclusion notices to 295 doctors, nurses, and other providers based on conduct related to opioid diversion and abuse. Takedowns protect Medicare and Medicaid and deter fraud — sending a strong signal that theft from these taxpayer-funded programs will not be tolerated. The money taxpayers spend fighting fraud is an excellent investment: For every $1.00 spent on health care-related fraud and abuse investigations in the last three years, more than $5.00 has been recovered.

2016 National Health Care Fraud Takedown

The Department of Health and Human Services Office of Inspector General, along with our state and federal law enforcement partners, participated in the largest health care fraud takedown in history in June 2016. Approximately 300 defendants in 36 judicial districts were charged with participating in fraud schemes involving about $900 million in false billings to Medicare and Medicaid. Takedowns protect Medicare and Medicaid and deter fraud — sending a strong signal that theft from these taxpayer-funded programs will not be tolerated. The money taxpayers spend fighting fraud is an excellent investment: For every $1.00 spent on health care-related fraud and abuse investigations in the last three years, more than $6.10 has been recovered.