Summary of Last Year’s Health Care Enforcement Actions

For the 2018 fiscal year, the Department of Health and Human Services Office of Inspector General (OIG) recently reported results of health care investigations that included the following:

• Over $2.3 billion in fraud judgments, settlements, and other administrative actions were implemented;
• The Department of Justice (DOJ) opened 1,139 new criminal health care fraud cases;
• Criminal fraud charges were filed in 572 cases involving 872 defendants;
• There were 497 defendants convicted of health care fraud-related crimes;
• The DOJ opened 918 new civil health care fraud cases;
• FBI cases resulted in over 812 operational disruptions of criminal fraud organizations;
• OIG cases resulted in 679 criminal and 795 civil actions; and
• There were 1,267 OIG exclusions for criminal convictions, 201 exclusions for patient abuse/neglect, and 996 exclusions that included licensure revocations.

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.