Article
Source: Criminal Justice Magazine
Article
02.14.17
Over the past 10 years, Department of Justice (DOJ) Criminal Division “Strike Force” teams have dramatically increased their efforts to combat public health care fraud by seeking to reduce the Centers for Medicare & Medicaid Services (CMS) estimates to be an annual loss of $60 billion to waste, fraud, and abuse through improper payments. DOJ prosecutors have also greatly benefited from the assistance of Department of Health and Human Services (HHS), with which they established a joint Health Care Fraud Prevention and Enforcement Action Team (HEAT) in 2009 to combat health care fraud. As a result, as of June 2015, Strike Force teams have commenced over 2,300 health care fraud prosecutions resulting from a broad range of allegations including false billing based on unnecessary or nonexistent medical treatment, illegal kickbacks, self-referrals, and other misconduct including obstructing health care fraud investigations.
As publicized by recent high-profile enforcement actions and investigations, federal prosecutors have been targeting the entire health care industry, including hospital networks and individual practitioners, and are now focusing on one of the most common and generally successful medical procedures employed to prevent the country’s leading cause of death: heart stenting. The article provides an overview of such criminal and civil enforcement efforts and discusses the medical and legal controversy surrounding what federal prosecutors and some experts believe are unnecessary stent procedures.