HHS, OIG and DOJ Fight Health Fraud

New Five Point Strategy Revealed

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[By Staff Reporters]

According to the Report on Medicare Compliance, October 20, 2008, the Health and Human Services [HHS] Office of Inspector General [OIG] recently unveiled a five-point strategy for fighting fraud and abuse in anticipation of a new presidential administration.

Five Pillars

The five “pillars” are:

  1. scrutinize who is allowed to bill before enrollment.
  2. establish reasonable and responsive payment methodologies.
  3. help industry adopt practices that promote compliance.
  4. vigilantly monitor claims for payment, and;
  5. respond quickly to detected fraud.

OIG and DOJ

Among other activities, the OIG and Department of Justice [DOJ is using data mining to identify claims problems before they get out of hand.

Assessment

For example, the Office of Evaluation and Inspections [OEIs] issued a 2006 report on aberrant physical therapy billing – physicians were billing for services performed by unlicensed people in the patients’ homes – while an OIG attorney deputized by the Department of Justice [DOJ] is now prosecuting cases based on this violation in the Southern District of Mississippi.

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