• The federal government is aggressively pursuing healthcare fraud investigations and prosecutions. The U.S. Department of Justice (DOJ) opened 983 criminal healthcare fraud investigations in fiscal year 2015 and filed criminal charges in 463 cases involving 888 defendants. Federal courts returned convictions against 613 defendants in healthcare fraud-related crimes in the same period. Since 2007, the Medicare Fraud Strike Force has charged more than 2,536 individuals involved in more than $8 billion of alleged fraud.
  • Thousands of pages of U.S. Code and agency regulations govern reimbursement rules under Medicare, Medicaid, TRICARE and other programs. Notwithstanding the best of intentions, all healthcare organizations and executives are vulnerable to fraud investigations and charges.
  • The False Claims Act (FCA), which provides monetary rewards for individual relators – or whistleblowers – of up to 30 percent of recovered funds, has provided a powerful inducement for employees to look for reimbursement improprieties, whether real or inadvertent.