The Federal Government validated its increased emphasis on fighting health care fraud in the OIG’s Semi-Annual Report to Congress for FY 2007. The OIG reported savings and expected recoveries resulting from its efforts of $43 billion—$5 billion more than last year and more than double the savings and recoveries of just five years ago. OIG’s FY 2007 $43 billion in savings encompasses $39 billion in implemented recommendations and other actions to put funds to better use, $1.9 billion in audit receivables and $2.1 billion in investigative receivables. Additionally, the OIG reported exclusions of 3,308 individuals and entities for engaging in fraud or abuse with respect to the Federal Healthcare programs and/or their beneficiaries, 447 criminal actions against individuals or entities that engaged in crimes against federal programs and 262 civil actions, which include False Claims Act and unjust enrichment suits filed in district court, civil monetary penalty law settlements and administrative recoveries related to provider/self disclosure matters. All in all, it was a record breaking year for the OIG. Amongst the largest settlements/prosecutions reported included the payment of nearly $635 million by Purdue Frederick Company, Inc. and Purdue Pharma, LP for their fraudulent marketing of OxyContin, the recovery of $54.3 million in the south Florida Medicare fraud related to HIV/AIDS infusion therapy and $42.65 million settlement with revenue maximization consulting business Maximus, Inc.
Additionally, the OIG has entered into corporate integrity agreements with the five largest orthopaedic implant manufacturers in the United States incident to the payment of nearly $311 million in civil penalties by those manufacturers relating to allegations of violation of the Federal Anti-Kickback Statute.
Looking ahead the OIG noted that it would continue to focus its attention on "payment integrity" of the Medicare/Medicaid programs, quality of care, food, drug and medical device safety as well as ethics program oversight and enforcement.
Healthcare providers who believe their industry is a focus of an inordinate amount of scrutiny from the federal government can look forward to more of the same in FY 2008.