New HHS OIG fraud unit to levy fines, exclusions—and target physicians

Dive Brief:

  • The Office of the Inspector General at HHS announced Tuesday the creation of a new litigation team that will concentrate on identifying and fining Medicare and Medicaid fraud. The team's creation is intended to put further pressure on physicians, drugmakers and other healthcare organizations suspected of bilking the federal government. 
  • The team was created in March and will have around 10 attorneys when hiring is complete. It will levy primarily civil monetary penalties and concentrate on excluding bad actors from Medicare and Medicaid programs. 
  • According to Lisa Re, chief of the OIG's administrative and civil remedies branch, the types of cases that will face the most enforcement are those that impact medical judgment—suggesting that physicians will be heavily targeted. 

Dive Insight:

The creation of a specific department dedicated to rooting out fraud isn't surprising, given the federal government's ongoing crackdown across Medicare and Medicaid, but this should serve as a warning to providers—especially independent physicians who lack the resources that large organizations have to ensure billing compliance. Docs "need to step up their game on compliance," said OIG veteran Tony Maida (now McDermott Will & Emery). 

"What you're going to see are a lot of kickback cases, both against the payor of the kickbacks … and the recipient of the kickbacks, which tend to be physicians," Re said. 

Filed Under: Health Law Policy & Regulation
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