Presented by Hodgson Russ, the Whistleblower Blog is written by a team of lawyers experienced in successfully guiding both whistleblowers and companies accused by whistleblowers of wrongdoing through the False Claims Act process.

Fraud-Fighting Report Request From Health and Human Services

While Medicare and Medicaid fraud recoveries last year totaled $4 billion, some estimate that the amount of fraud going undetected at HHS is many times higher than this. There is room for improvement through HHS’s own efforts as well as through qui tam whistleblowers.

Among other things, Hatch and Baucus requested that HHS OIG provide each quarter:

• The amount of funds obligated from the overall current budget and the areas these funds have been allocated to (e.g., investigations, audits, evaluations, training)

• The number of investigations opened and closed, and information about the disposition of the investigations

• The number of corporate integrity agreements (CIAs) entered into and closed, and descriptions of any actions taken regarding breaches of CIAs (CIAs often result from False Claims Act liability findings or settlements)

• The number of civil monetary penalty or other administrative actions initiated, and any sanctions or other steps taken related to those actions

They requested that CMS provide, among other things:

• A breakdown by industry segment (e.g., home health, durable medical equipment, physician) for each month showing how many applications were screened, the number of providers/suppliers flagged using the new screening tools, and the number of providers/suppliers denied billing numbers as a result of the process

• The number of suspensions currently in place, any new suspensions initiated, who initiated the suspensions, the number and length of suspensions extended, and any actions taken as a result of suspensions that were lifted

• The total number of administrative actions (e.g., overpayment determinations, sanctions, or civil monetary penalties) imposed by CMS, the duration and/or dollar value of those actions, and the resolution of those actions

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