OIG report shows continued emphasis on false claims
OIG report shows continued emphasis on false claims
The Health and Human Services’ (HHS) Office of Inspector General’s (OIG) Semi-Annual Report, released this month, shows a remarkably steady effort to root out fraud and abuse that continue to be spearheaded by the False Claims Act. "Almost all of our action these days involves False Claims Act cases brought by relators and then worked on by the government," reports J.D. Epstein, a partner with Vinson Elkins in Houston. "That is the front line right now."
Epstein says it is still difficult to assess where the government is in terms of False Claims Act cases relating to the Stark self-referral laws. "We have seen none," he reports. "We still don’t have the final Stark II regulations, and I think the government is a bit uneasy about bringing cases under Stark without final regulations."
Kickbacks are another story, Epstein says. The OIG highlights this area in its most recent report, citing several major settlements involving physicians and durable medical equipment companies.
Marc Raspanti of Miller Alfonso in Philadelphia, predicts this trend will continue as the number of physicians who are willing to blow the whistle on hospitals, competitors, and HMOs continues to increase. Once-common interactions with pharmaceutical companies and ancillary service providers, such as educational grants, lavish dinners, and payments for new drug trial runs, now are perceived as criminal. "These areas will be looked at by the government as potential inducements for referrals," he says.
The OIG reports $10 billion in savings for the first half of fiscal year 2001. Most of that — $9.5 billion — was attributed to implemented recommendations and other actions to put funds to better use. Another $335 million was realized in audit disallowances, and the remaining $249 million came from investigative receivables.
The OIG also reports 1,610 exclusions of individuals and entities for fraud and abuse of federal health care programs, 213 convictions of individuals or entities that engaged in crimes against departmental programs, and 209 civil actions.
The OIG reports that it is still investigating more than 100 hospitals under its pneumonia upcoding initiative. To date, 23 hospitals have settled their liability for upcoding by paying more than $23.7 million. Settlements stemming from the Physicians at Teaching Hospitals initiative now stand at almost $99 million, while 2,799 hospitals have now settled with the government for over $73 million for investigations related to the Three-Day Window project.
The OIG also reports that, between Oct. 1, 2000 and March 31, 2001, it collected $325,000 in settlement amounts from 15 hospitals and physicians for violations related to the patient anti-dumping statute.
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