The following is a summary of the federal Health and Human Services agency's Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country.¹ The enforcement actions reported are based upon federal and individual states' activity.

The summaries reflect areas of OIG's and individual states' current and recent enforcement activity.² Knowing where regulators' attention is focused can help healthcare providers identify areas of focus for compliance and risk assessment activities. Although not all the enforcement actions may be relevant to any one provider's healthcare business, there may be some summaries that could be used as examples in compliance program education programs ("What to avoid"), or used in developing a risk management plan.

Of Note in this Issue:

1. OIG's use of Federal Debt Collection Procedures Act to recover fraud proceeds from a person who received proceeds from a fraudulent act, but was not involved in the actual fraud. (See June 7^th summary.)
2. Multiple reports of prosecution for beneficiary fraud.

Key:

• AG = Attorney General
• AKS = Anti-Kickback Statute
• CIA = Corporate Integrity Agreement
• CMP = Civil Monetary Penalties
• CMS = Centers for Medicare and Medicaid Services
• CPT = Current Procedural Terminology Codes
• DME = Durable Medical Equipment
• E&M = Evaluation & Management services
• FEHBP = Federal Employees Health Benefits Program
• FMV = Fair Market Value
• DOJ = United States Department of Justice
• FCA = False Claims...

Read Full Story: https://www.mondaq.com/unitedstates/white-collar-crime-anti-corruption-fraud/...