Justice Department adhering to guidelines, GAO says

A new report from the General Accounting Office (GAO) concludes that the Department of Justice (DOJ) has improved its adherence to its own guidance on using the False Claims Act to pursue allegations of Medicare fraud and abuse over the past year. The DOJ has been accused of overzealous and improper actions in using the False Claims Act, but in a report released on March 30, the GAO says the "DOJ has made progress in correcting these problems." Since April 2000, GAO has been looking specifically at DOJ’s pneumonia upcoding and prospective payment system (PPS) transfer projects.

Certifying compliance

The recent report from the GAO notes the DOJ requires all U.S. Attorney Offices involved in civil health care fraud control to certify their compliance with the guidance issued by the DOJ. That directive "appears to have promoted compliance at the offices we visited. We found that these offices had either documented their compliance in case files or instituted a review process . . .

"Our review also suggests that DOJ is implementing its two most recent and active national initiatives, the PPS Transfer and Pneumonia Upcoding projects, in a manner that is consistent with the guidance. Our review indicated that the working groups had conducted sufficient background research and developed legal and factual bases underlying the initiatives."

The GAO also says it is clear the health care industry is not satisfied with how the False Claims Act is being used. "The hospital association representatives we spoke with continue to express concerns about the appropriateness of DOJ’s use of the False Claims Act in civil health care matters, but did not identify specific examples of noncompliance with the guidance among U.S. Attorney Offices. Officials from DOJ’s Executive Office for U.S. Attorneys and its Civil Division generally concurred with our findings and conclusions."