For fiscal year 2011 alone, Congress has designated up to US$105 million of additional funding to target health care fraud and abuse, in addition to the current funding of up to US$1.3 billion. This significant increase will improve the Office of Inspector General’s (OIG) ability to prosecute health care fraud and abuse by:

  • Targeting fraud in more cities including expanding the locations of Medicare Fraud Strike Force Teams from seven cities to 20;
  • Identifying new trends in potential fraud and abuse including specific types of claims that are more susceptible to fraud and abuse;
  • Prosecuting more individuals and entities including “low hanging fruit;”
  • Increasing the OIG’s use of technology to investigate and prosecute cases quicker and more efficiently; and
  • Supporting the efforts of the Health Care Fraud Prevention and Enforcement Action Team, a senior-level joint task force of the OIG and the US Department of Justice.

The OIG and the Attorney General have recently been given access to the payment and claims data in the expanded and searchable Integrated Data Repository of the Centers for Medicare & Medicaid Services. In addition, the OIG now has the authority to obtain information about claims directly from individuals, including beneficiaries, and a variety of entities that directly or indirectly provide or receive medical or other items or services payable by any federal health care program. These additional resources will allow the OIG to:

  • Proactively analyze suspicious patterns in emerging claims data including unusual, clinically inconsistent or high volume billings;
  • Access claims data from additional agencies, such as the Veterans Administration;
  • Quickly identify dramatic spikes in claims for a particular type of treatment or equipment in a geographic area; and
  • Target and investigate potential fraud faster and more efficiently.

In addition the OIG now utilizes cutting-edge technology for reviewing large quantities of emails and electronic data that will assist OIG in its investigations and prosecutions by:

  • Significantly cutting down the amount of time, potentially by months, that it takes to review voluminous emails and electronic data obtained in investigations;
  • Identifying associations among emails contained in multiple accounts based on content, fields and metadata;
  • Permitting investigators and prosecutors to access the electronic information securely from anywhere in the country; and
  • Allowing for greater and easier collaboration among the different agencies and local law enforcement working with them on federal prosecutions.