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The Department of Health and Human Services (HHS) attributes the "remarkable progress" it has made in rooting out health care fraud and abuse to the landmark Health Insurance Portability and Accountability Act of 1996 (HIPAA). It also notes in its semiannual report that the seven-year Health Care Fraud and Abuse Control Program established by HIPAA is only at its midpoint.
"With the number of HHS OIG [Office of Inspector General] civil actions, criminal prosecutions, and exclusions on the rise, as evidenced by the semiannual report, the industry should see this as a clear sign that the federal government is not going to let up on its efforts to combat fraud and abuse in the health care system," says Richard Kusserow, president & CEO of Strategic Management Systems in Alexandria, VA.
In the last four fiscal years under HIPAA, HHS reports overall savings of more than $47.3 billion, with Medicare and Medicaid accounting for more than 98% of the total savings.
For FY 2000, the OIG reports savings of $15.62 billion with the lion’s share coming from implemented recommendations. About $1.232 billion is attributed to investigative receivables and the remaining $142 million to audit disallowances.
For the fiscal year, the OIG reports 3,350 exclusions of individuals and entities, up from 2,976 the year before. The OIG also reports a slight increase in the overall number of criminal prosecutions of individuals or entities that engaged in crimes against department programs, 414 (compared to 401 in FY 1999) as well as 357 civil actions.
There will continue to be increased resources from HIPAA through FY 2003. "What this shows is that when you pour more resources into a problem, you are going to get more enforcement activity, convictions, and exclusions," says John Bentivoglio of Arnold and Porter in Washington, DC. "What the industry has faced so far is merely going to increase as more and more resources are devoted to this problem."