Medicare Compliance & Reimbursement

Allowing your commitment to compliance to waver could cost you big.  Think the campaign against health care fraud and abuse is easing up? The latest statistics from the Department of Justice should change your mind. In fiscal year 2003 - which ended Sept. 30 - the DOJ reeled in $1.7 billion in civil fraud recoveries against health care companies. Put another way, fraud settlements are costing health care organizations more than $6.5 million per business day. Health care fraud also represents the lion's share of the $2.1 billion in total fraud recoveries netted by the DOJ in FY 2003, with defense procurement fraud settlements - totaling just under $300 million - taking a distant second. The $2.1 billion figure represents a 75 percent jump over last year's total, according to the DOJ. "The record recoveries in civil fraud cases demonstrate this administration's unwavering commitment to combat fraud and to ensure that tax dollars are well spent," says Assistant Attorney General Peter Keisler. The past year's big health care cases include: HCA Inc.'s $641 million payout for cost report fraud and kickbacks (which, combined with earlier settlements, brings HCA's price tag in connection with the seminal fraud probe against it to $1.7 billion);

Abbott Laboratories' and its Ross Products Division's $382 million settlement arising from a sting operation in which government investigators posed as representatives of a durable medical equipment supply company; and AstraZeneca Pharmaceuticals' $280 million settlement for conspiring with physicians to illegally charge Medicare and Medicaid for free drug samples. Lesson Learned: The federal government remains aggressive in its pursuit of health care fraudsters.