On May 20, 2009, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud. Holder and Sebelius also announced the expansion of Strike Force team operations to Detroit and Houston.  Medicare Fraud Strike Forces, currently in operation in South Florida and Los Angeles, fight Medicare fraud on a targeted local level.

On May 21, 2009, the OIG posted an advisory opinion regarding a proposal to compensate physicians for on-call services performed on behalf of it’s uninsured patients.  Although the OIG acknowledged the legitimate reasons for such arrangements, they also stated there is a substantial risk that improperly structured payments for on-call coverage could be used to disguise unlawful remuneration.  However, the key inquiry is whether the compensation is: (i) fair market value in an arm’s-length transaction for actual and necessary items

On January 13, 2009, Attorney General Andrew M. Cuomo announced that Ingenix was at root of fraud scheme and that as a result a historic reform of the nationwide health care reimbursement system is needed that will end conflicts of interest and generate fair reimbursement rates for working families nationwide.

Wisconsin FCA Passes Muster With OIG

The OIG, on November 4, 2008, found that the Wisconsin False Claims Act meets the requirements of the Deficit Reduction Act, thus entitling Wisconsin to an increase of 10 percentage points in the State medical assistance percentage with respect to any amounts recovered under a State action brought under such a law.

Health Care Compliance Update: June 2008

Hot Topics• Recovery Audit Contractors• Medicaid Enforcement• OIG’s revised self-disclosure requirements• Electronic medical records/Health information technology• Quality of care• Hospital acquired conditions or “Never events”

Health Care Compliance LetterVolume 11-10, May 13, 2008

Fraud and Abuse