In order to increase patient safety and protect taxpayers, the federal government is serious about reducing fraud and abuse in the Medicare and Medicaid programs and have zeroed in on health care providers. The Department of Justice (DOJ) joined forces with the Department of Health and Human Services (HHS) to form the HEAT task force (Health Care Fraud Prevention and Enforcement Action Team).
HEAT has significantly increased recovery of improper Medicare and Medicaid charges. HEAT has also used the False Claims Act to pursue criminal charges against practitioners. The False Claims Act was enacted by Abraham Lincoln to prosecute Civil War profiteers. HEAT uses the Act to prosecute healthcare providers who submit fraudulent charges for medical services. CMS reports that the value of charges recovered nearly doubled between FY 2009 and FY 2011 to $4.1 B http://1.usa.gov/xVofSA.
When practitioners don’t communicate diagnostic test results sufficiently, they put patients at risk. Under the False Claims Act, they may also be accused of fraud. Criminal prosecutions increased 75% between 2009 and 2011 and they’re still on the prowl.
The best protection for both patients and practitioners is robust notification, and documentation of communication.