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Latest Top (4) News


Health and Human Services and the Department of Justice Return $2.6 Billion in Taxpayer Savings from Efforts to Fight Healthcare Fraud

Health and Human Services Secretary Alex Azar and Attorney General Jeff Sessions today released a fiscal year (FY) 2017 Health Care Fraud and Abuse Control Program report showing that for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4. Additionally, the report shows that the departments’ FY 2017 Takedown event was the single largest healthcare fraud enforcement operation in history.

In FY 2017, the government’s healthcare fraud prevention and enforcement efforts recovered $2.6 billion in taxpayer dollars from individuals and entities attempting to defraud the federal government and Medicare and Medicaid beneficiaries. Some of these fraudulent practices include:

  • Providers operating “pill mills” out of their medical offices.
  • Providers submitting false claims to Medicare for ambulance transportation services.
  • Clinics submitting false claims to Medicare and Medicaid for physical and occupational therapy.
  • Drug companies paying kickbacks to providers to prescribe their drugs, and pharmacies soliciting and receiving kickbacks from pharmaceutical companies for promoting their drugs.
  • Companies misrepresenting capabilities of their electronic health record software to customers.

“Today’s report highlights the success of HHS and DOJ’s joint fraud-fighting efforts,” said HHS Secretary Azar. “By holding individuals and entities accountable for defrauding our federal health programs, we are protecting the programs’ beneficiaries, safeguarding billions in taxpayer dollars, and, in the case of pill mills, helping stem the tide of our nation’s opioid epidemic.”

“Taxpayers work hard every day to help fund government programs for our fellow Americans,” Attorney General Sessions said. “But too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and exploit this generosity to line their pockets, sometimes for millions of dollars.  At the Department of Justice, we have taken historic new actions to incarcerate these criminals and recover stolen funds, including executing the largest healthcare fraud enforcement action in American history.  These achievements are important, but the department's work is not finished. We will keep up this pace and continue to prosecute fraudsters so that we can give financial relief to taxpayers.”

The departments of Justice (DOJ) and Health and Human Services (HHS), through the Health Care Fraud Prevention and Enforcement Action Team (HEAT) effort, use data analytics and surveillance to crack down on, prevent and prosecute healthcare fraud. While the program continues to be very successful, the return on investment fluctuates from year to year, in part because cases resulting in large settlements take multiple years to complete. Additionally, there has been a reduction in large monetary settlements as many of the large pharmaceutical manufacturers have entered into Corporate Integrity Agreements with the HHS Office of the Inspector General to establish protections against fraudulent activities.

With teams comprised of law enforcement agents, prosecutors, attorneys, auditors, evaluators and other staff, last year DOJ opened 967 new criminal healthcare fraud investigations of which federal prosecutors filed criminal charges in 439 cases involving 720 defendants.  A total of 639 defendants were convicted of healthcare fraud related crimes. In FY 2017, the DOJ and HHS joint Medicare Fraud Strike Force filed 253 indictments and charges against 478 defendants who allegedly billed federal healthcare programs more than $2.3 billion. The Strike Force obtained more than 290 guilty pleas, litigated 33 jury trials and won guilty verdicts against 40 defendants. The Fraud Strike Force secured prison sentences for more than 300 defendants, with an average sentence of 50 months. Since its inception in 2007, Strike Force prosecutors filed more than 1,660 cases charging more than 3,490 defendants who collectively billed the Medicare program more than $13 billion.

Beyond criminal prosecution, the HHS Office of Inspector General (OIG) remains vigilant in excluding providers and suppliers who committed fraud or engaged in the abuse or neglect of patients in federal health programs. A total of 3,244 individuals and entities were excluded in FY 2017. Others were excluded as a result of licensure revocations. These exclusions help to safeguard beneficiaries from future harm that could otherwise be inflicted by such convicted individuals or entities. HHS can also suspend Medicare payments to providers during investigations of credible allegations of fraud.  During FY 2017, there were 551 related payment suspensions.  More than 4 million claims are reviewed by Medicare each day; resulting in more than one billion claims processed annually for timely payments to healthcare providers and suppliers. Given the volume of claims processed by Medicare each day and the significant cost associated with conducting medical review of an individual claim, the Centers for Medicare and Medicaid Services uses automated edits to help prevent improper payments without the need for manual intervention.  The National Correct Coding Initiative consists of edits designed to reduce improper payments in Medicare Part B, and this program saved Medicare $186.9 million during the first nine months of FY 2017.

As the opioid epidemic continues to devastate communities and families across the nation, both DOJ and HHS are responding with new approaches. One out of every three beneficiaries received prescription opioids through Medicare Part D in 2016. Additionally, 401 prescribers were found to have questionable prescribing patterns for beneficiaries at serious risk of opioid misuse or overdose, based on an OIG analysis. Last July, DOJ and HHS announced the largest ever healthcare fraud enforcement action, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in healthcare schemes involving approximately $1.3 billion in false billings. Of those charged, more than 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

In August, Attorney General Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit, a new DOJ pilot program that will use data to help combat and prosecute individuals and entities involved in illegal activities that fuel the crisis. As part of that task force, the department funded 12 experienced assistant United States attorneys for a three-year term to focus solely on investigating and prosecuting healthcare fraud related to prescription opioids, including pill mill schemes and pharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes. Those prosecutors have already charged several with unlawful distribution of opioids, and their continued success is crucial in combatting this deadly epidemic.

For more details on the Health Care Fraud and Abuse Control Program and today’s report, visit: https://oig.hhs.gov/publications/docs/hcfac/FY2017-hcfac.pdf



Friday, April 6, 2018 - 11:00


Secretary Azar Announces Appointments for the Department of Health and Human Services

Assistant Secretary for Public Affairs –Judy Stecker began her tenure yesterday as the Assistant Secretary for Public Affairs. Stecker came to the Department from the American Enterprise Institute (AEI), where she served as Executive Director of Media Relations and Strategic Marketing. At AEI, she was responsible for developing strategic media and marketing plans, implementing and evaluating publicity tools, brand management and crisis communications. Prior to joining AEI, Stecker served as Senior Media Associate for Broadcast Services at the Heritage Foundation. Before that, she was Director of Communications for the Foundation for Defense of Democracies and Director of Communications for Vets for Freedom.

Principal Deputy Assistant Secretary for Public Affairs – Jeff Rosenberg began his tenure last week as the Principal Deputy Assistant Secretary for Public Affairs. Rosenberg has more than 30 years of providing high-level strategic communications guidance to government agencies and leading nonprofit organizations and foundations. Before joining the Department, he most recently served as an Executive Vice President at Crosby Marketing Communications, directing major integrated communications programs. Prior to this position, Rosenberg served as the President and Owner of Rosenberg Communications, his own firm, a full-service communications practice. Additionally, during President George H. W. Bush’s Administration, Mr. Rosenberg previously served at the Department as Director of Communications, Acting Associate Commissioner for Head Start, and Special Assistant to the Commissioner, Administration for Children, Youth, and Families.

Acting Assistant Secretary for Administration – HHS Deputy General Counsel Heather Flick has been named the acting Assistant Secretary for Administration – a role she will fill until a new Assistant Secretary for Administration is named. Flick started with the Department as part of the beachhead team as Deputy General Counsel, was promoted to Principal Deputy General Counsel; she served as Acting General Counsel until the General Counsel Robert Charrow was confirmed by the Senate. Before her service with the Department, Flick was of counsel with Dhillon Law Group in San Francisco and owner of The Flick Group practicing corporate law, specializing in mergers and acquisitions, licensing, employment law, IP protection and arbitration.

Deputy Administrator and Director of the Centers for Medicare & Medicaid Innovation (CMMI) – Adam Boehler joins the Department next week in the role of Deputy Administrator and Director of CMMI. Boehler is the former CEO and founder of Landmark Health – a company focused on delivering medical services to the most chronically ill patients. Boehler is the founder of Avalon Health Solutions – a leading provider of laboratory benefit management services in the country. Boehler was a board member and founder of TrellisRx, a built-for-purpose company that partners with health systems to fund, build, and operate specialty pharmacies. Additionally, Boehler was an Operating Partner at Francisco Partners a leading global private equity firm focused on healthcare technology and services investing, including both the incubation of built-for-purpose companies and execution of transactions involving established, high-growth businesses.

Senior Advisor to the Secretary for Drug Pricing Reform – Dan Best began his tenure this week as the Senior Advisor to the Secretary for Drug Pricing Reform. A highly accomplished, healthcare industry executive, Best is an expert on both the pharmaceutical landscape and the Medicare Part D program. He recently served as the Corporate Vice President of Industry Relations for CVSHealth’s Medicare Part D business. Prior to working at CVS, Best spent 12 years at Pfizer Pharmaceuticals.



Friday, April 6, 2018 - 17:00


Update from the Department of Health and Human Services

Today, the Department of Health and Human Services issued the following statement:

Earlier today, the Secretary of Health and Human Services, Alex M. Azar II, was discharged from St. Vincent’s Hospital in Indianapolis, Indiana after he was admitted yesterday for treatment of a minor infection. The Secretary has been fully functional during his brief period of observation and has been in regular contact with HHS senior leadership. He will be back in the office tomorrow in Washington, D.C.

The Secretary and his family thank everyone for their concerns and well wishes. They are extremely grateful for the incredible doctors and nurses who provided him with excellent care during his one-night stay at St. Vincent’s.

This serves as an update following yesterday’s statement which can be read at https://www.hhs.gov/about/news/2018/04/15/update-from-hhs.html.



Monday, April 16, 2018 - 14:45


Update from the Department of Health and Human Services

Today, the Department of Health and Human Services issued the following statement:

Earlier this evening the Secretary of Health and Human Services, Alex M. Azar II, was treated with intravenous antibiotics for a minor infection. Out of an abundance of caution he has been admitted to a hospital for observation.



Sunday, April 15, 2018 - 21:15