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The Department of Health and Human Services
And
The Department of Justice
Health Care Fraud and Abuse Control Program
Annual Report For FY 2008
September 2009
TABLE OF CONTENTS
Department of Health and Human Services
Department of Justice
GENERAL NOTE
All years are fiscal years unless
otherwise noted in the text.
EXECUTIVE SUMMARY
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a nationalHealth Care Fraud and Abuse Control Program (HCFAC or the Program), under the jointdirection of the Attorney General and the Secretary of the Department of Health and HumanServices (HHS)
1
, acting through the Department’s Inspector General (HHS/OIG), designed tocoordinate Federal, state and local law enforcement activities with respect to health care fraudand abuse. In its twelfth year of operation, the Program’s continued success again confirms thesoundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud or abuse, and to protect program beneficiaries.Moreover, the Program’s investment in criminal and civil health care fraud enforcement effortshas yielded an impressive “return on investment’ for the American taxpayer: for every HIPPAdollar spent by DOJ and HHS on federal health care fraud enforcement, approximately $4 has been recovered and returned.
Monetary Results
During FY 2008, the Federal Government won or negotiated approximately $1 billion in judgments and settlements
2
, and it attained additional administrative impositions in health carefraud cases and proceedings. The Medicare Trust Fund received transfers of approximately$1.94 billion during this period as a result of these efforts, as well as those of preceding years, inaddition to over $344 million in Federal Medicaid money similarly transferred separately to theTreasury as a result of these efforts. The HCFAC account has returned over $13.1 billion to theMedicare Trust Fund since the inception of the Program in 1997.
Enforcement Actions
In FY 2008, U.S. Attorneys' Offices opened 957 new criminal health care fraud investigationsinvolving 1,641 potential defendants. Federal prosecutors had 1,600 health care fraud criminalinvestigations pending, involving 2,580 potential defendants, and filed criminal charges in 502cases involving 797 defendants. A total of 588 defendants were convicted for health carefraud-related crimes during the year. Also in FY 2008, the Department of Justice (DOJ) opened843 new civil health care fraud investigations and had 1,311 civil health care fraud matters pending.
1
Hereafter, referred to as the Secretary.
2
The amount reported as won or negotiated only reflects federal recoveries and thereforedoes not reflect state Medicaid monies recovered as part of any global, federal-state settlements.Measures have been put into place to track such related state Medicaid recoveries.1
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