In late November 2008, the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Justice (DOJ) released their annual fraud and abuse report for calendar year 2007. The report includes data on criminal prosecutions, civil recoveries and administrative recoupments by various DHHS agencies, including the Office of Inspector General (OIG), and by the DOJ.

According to the report, in 2007 the federal government won or negotiated approximately $1.8 billion in judgments and settlements related to health care fraud and abuse. In 2007, the U.S. Attorneys’ offices initiated 878 new criminal health care fraud investigations involving 1,548 potential defendants. During 2007, federal prosecutors reported 1,612 open investigations involving 2,603 potential defendants, and filed actual criminal charges in 434 cases involving 786 defendants. A total of 560 defendants were actually convicted of federal health care fraud crimes.

During that same period, the DOJ initiated 776 new civil investigations and DHHS opened 218 new civil investigations of its own. The report also highlights some of the more significant cases initiated by the federal government and some of its perceived successes. The good news coming from all this data is that none of the cases highlighted in the report directly involved nursing facility providers.

However, a number of the investigations and/or convictions did involve providers who offer ancillary services that could be utilized by nursing facilities, including DME providers, dental providers, and physicians, among others. This underscores the importance of nursing facilities’ careful review of their contracts and actual operations with ancillary services providers in order to ensure that they pass muster under both federal and state health care fraud and abuse laws.