1999 Stark and Fraud and Abuse Update

April 05, 2000

The Department of Health and Human Services' Office of Inspector General ("OIG") touts significant increases in criminal convictions, exclusions from Federal health care programs and civil settlements.(2) Federal prosecutors filed 371 criminal indictments in the health care fraud cases in 1999, a 16% increase over 1988. A total of 396 defendants were convicted for health care fraud-related crimes in 1999, there were 2,278 civil matters pending and 91 civil cases filed in 1999. The federal government achieved judgments, settlements and administrative fines in health care fraud cases and proceedings involving in excess of $524,000,000, and in connection with those and prior year actions collected $490,000,000 (with the greatest bulk of these amounts constituting restitution and compensatory damages) in 1999. The Department of Health and Human Services excluded 2,976 individuals and entities from participation in Medicare, Medicaid and other federal programs. Qui tam relators were awarded over $44,000,000. At the close of 1999, the OIG was monitoring more than 425 corporate integrity agreements. In citing progress in the fight against fraud and abuse, the OIG is clear that its continuing focus is on illegal kickbacks which Inspector General June Gibbs Brown has in at least one instance referred to as "sophisticated" fraud.(3)

In 1999, the administration launched a new national health care fraud task force, in which various agencies will work together to form strategies to combat health care fraud abuse. The agencies have also engaged in outreach programs directed to Medicare beneficiaries to obtain grassroots involvement against Medicare fraud, waste and abuse.

Another clear development has been the increasing interests by federal prosecutors around the country and prosecuting healthcare fraud and abuse, and sophistication in doing so, which was previously limited to select Assistant U.S. Attorneys.

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