Health Care Fraud Provisions in Federal Bill Passed Last Night

The Health Care bill that passed last night provides for additional funding to the Health Care Fraud and Abuse Control Program (HCFAC). This program was established as a part of the Heath Insurance Portability and Accountability Act (HIPAA) in 1996 “to combat fraud committed against all health plans, both public and private.” The HCFAC program coordinates federal, state, and local law enforcement actions with respect to health care fraud and abuse.

Section 1304 of the bill passed last night provides additional funding to the tune of $250 million between 2011 and 2016 to the HCFAC program. The HCFAC Account is funded by the Federal Hospital Insurance Trust Fund pursuant to 42 U.S.C. ยง 1395i(k). It covers the costs of:
(i) prosecuting health care matters (through criminal, civil, and administrative proceedings);
(ii) investigations;
(iii) financial and performance audits of health care programs and operations;
(iv) inspections and other evaluations; and
(v) provider and consumer education regarding compliance.

Now is the time to reevaluate compliance programs and prepare for an increase in health care fraud investigations and prosecutions.

A copy of the bill is available here.
A section-by-section analysis of the bill is available here.