G2 News-At-A-Glance

Strike Force to Expand: The Medicare Fraud Strike Force, active in nine cities across the country, is likely to expand in the coming year, an official from the Department of Justice said Nov. 14. “Strike force expansion all comes down to the budget, but I think we’ll see more cities,” Sam G. Sheldon, deputy chief of the fraud section in DOJ’s criminal division, said during the National Health Care Anti-Fraud Association’s Annual Training Conference. Sheldon said the strike force concept has been a successful enforcement tool since it was rolled out in Miami in 2007, resulting in quicker prosecutions and increased law enforcement collaboration. In 2007, Sheldon said it was taking three to five years to prosecute a health care fraud case. Under the strike force approach, the time from opening an investigation to issuing an indictment has been trimmed to 90 days, he said. Besides Miami, strike force teams are active in Baton Rouge, La.; Brooklyn, N.Y.; Chicago; Dallas; Detroit; Houston; Los Angeles; and Tampa Bay, Fla. Over the last five years, 723 health care fraud cases have been filed by strike force teams, involving 1,440 defendants, and strike force prosecutors have won 105 trial convictions and garnered 917 guilty pleas. OIG Recovers $6.9 Billion: The Department of Health and Human Services Office of Inspector General Nov. 27 announced expected recoveries of $6.9 billion from fraud-related audits and investigations in fiscal year 2012, an increase from the $5.2 billion in recoveries the agency made in FY 2011, according to the OIG’s Semiannual Report to Congress. “The results of OIG’s audit, evaluation, enforcement, and compliance work underscore that the Department continues to face significant management and performance challenges in key areas, including reducing improper payments and avoiding waste, ensuring patient safety and quality of care, and overseeing program integrity contractors,” OIG Inspector General Daniel R. Levinson said in the report’s introduction. The expected recoveries included $924 million identified by OIG audits and $6 billion that resulted from agency investigations, the report said. In addition to the recoveries, the report identified an estimated $8.5 billion in savings in FY 2012 that were due in part to implemented OIG recommendations