Special Initiatives
Health Care Fraud & Abuse
The District's Health Care Task Force includes the U.S. Department of Health and Human Services, the Federal Bureau of Investigation, the Internal Revenue Service, the U.S. Postal Service, the Department of Defense, the Ohio Attorney General, the Ohio Bureau of Workers Compensation, the Ohio Department of Human Services, the State Auditor of Ohio, the Ohio State Medical Board, the Medicare Part A Intermediary, AdminaStar Federal, the Part B Carrier, Nationwide Insurance, and private insurers (many are members of the National Health Care Anti-Fraud Association).
Recent Task Force initiatives have resulted in criminal convictions and civil monetary recoveries against suppliers of durable medical equipment, nursing home suppliers, hospital and independent laboratories, podiatrists, and outpatient psychiatric programs. The types of fraud perpetrated include billing for services not rendered, billing for non-covered services, and inflating the cost of services.
The Health Insurance Portability and Accountability Act of 1996, a.k.a. Kennedy-Kassebaum, had an immediate impact on the ability of the government to deal with fraud and abuse. First, it provided funding for a number of new investigator, attorney and other professional positions in both the Departments of Justice and Health and Human Services. A trust fund, consisting of appropriations and recoveries from health care settlements and prosecutions, will finance the government's health care activities. The Act also required these two agencies to develop a coordinated set of guidelines dealing with the regulation, investigation and prosecution of health care fraud. The legislation enhances existing civil monetary penalty provisions, and created the crime of health care fraud.