Health care fraud enforcement continues to be a priority for the federal government and is poised to expand even more. In the fiscal 2015 budget, Congress more than doubled the appropriation to the Health Care Fraud and Abuse Control (HCFAC) program to $672 million, providing more money for oversight activities to the U.S. Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Justice (DOJ), and the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). Expanding oversight, ever-increasing numbers of law enforcement actions, and with greater public access to Medicare claims data and the information contained in the Open Payments database, indicate changes in the enforcement and compliance landscape to be aware of in proactively managing the organization’s compliance and risk assessment activities.
Ensuring that the organization’s compliance program is up-to-date and up-to-task in proactively identifying problems and making timely decisions about corrective actions and potential government disclosures is key to protecting the organization. In our most recent Over the Horizon: Fraud Enforcement Trends for 2015 article, a team of health care experts examine enforcement trends to watch and proactive steps to take in greater detail.