Key Takeaways from the HCFAC 2021 Annual Report

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. Every year since the program’s establishment in 1997, The Department of Health and Human Services (HHS) and The Department of Justice (DOJ) release an annual report detailing HCFAC’s results and accomplishments from the past fiscal year. This year’s 129-page report also includes information about the amounts deposited and appropriated to the Medicare Trust Fund, as well as the source of such deposits.

In this post, we will outline key takeaways from this year’s report as well as discuss how to ensure your organization is keeping compliant.

Monetary Penalties

During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. They also attained administrative impositions in healthcare fraud cases and proceedings. Because of these efforts, close to $1.9 billion was returned to the government or paid to private persons. Of this $1.9 billion, Medicare Trust Funds received approximately $1.2 billion of transfers, and approximately $98.7 million in federal Medicaid money was transferred to the Centers for Medicare & Medicaid Services (CMS).

Enforcement Actions and Exclusions

The DOJ opened 831 new criminal healthcare fraud investigations in 2021. 462 criminal charges were filed involving 741 defendants. Of these 741 defendants, 312 were convicted of healthcare fraud-related crimes. The DOJ also opened 805 new civil healthcare fraud investigations and had 1,432 civil healthcare fraud matters pending at the end of the fiscal year.

In addition, the investigative efforts of the Federal Bureau of Investigation (FBI) resulted in more than 550 operational disruptions of criminal fraud organizations. They also dismantled the hierarchy of more than 100 criminal healthcare fraud enterprises.

In 2021, The Office of Inspector General for the Department of Health and Human Services (HHS-OIG) conducted numerous investigations into individuals and entities involved in Medicare and Medicaid crimes. Their investigations resulted in 504 criminal actions and 669 civil actions, which include false claims and unjust-enrichment settlements, as well as civil monetary penalty (CMP) settlements.

The OIG excluded a total of 1,689 individuals and entities from participation in Medicare, Medicaid, and other federal healthcare programs. These exclusions are based on criminal convictions for crimes related to:

  • Medicare and Medicaid (569)
  • Healthcare licensure revocations (536)
  • Other healthcare programs (267)
  • Beneficiary abuse or neglect (145)

Key Takeaways

  • $5 billion won or negotiated in federal government fraud settlements
  • 1,689 individuals and entities excluded
  • 831 new criminal fraud investigations
  • 312 defendants convicted of healthcare fraud

It is clear that the HHS-OIG is active in its enforcement of activities related to health care fraud and abuse and will continue to take action against organizations that are not in compliance with state and federal requirements. Is your organization keeping pace by utilizing a comprehensive license and exclusion monitoring solution?

At ProviderTrust, we deliver healthcare’s most trusted ongoing OIG LEIE,, and state Medicaid exclusion list monitoring, thoughtfully engineered for every unique population. Our exclusion monitoring solution is fully automated- screening your employees, providers, and vendors against every state and federal exclusion source every single day. We’ll never miss a primary source list update, a new hire added, or anything in between.

From OIG exclusions to licenses and credentials, our healthcare monitoring and verification platform goes beyond good enough.

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