In recent years, the government has been taking a much more aggressive approach to health care fraud enforcement, and it looks like enforcement efforts could get even more aggressive under the Trump administration.
Even though overall funding for the Department of Health and Human Services was cut by $15 billion in the Trump administration's proposed budget blueprint for fiscal year 2018, the Health Care Fraud and Abuse Control account will get a boost of $70 million, bringing the total to $751 million in discretionary funding.
HCFAC is a federal program that manages health care fraud and abuse enforcement efforts between federal, state and local law enforcement.
Gov is seeing a return on investment
Over the past several years, anti-fraud efforts have returned on investment, which is likely why the Trump administration decided to throw more money at the HCFAC program despite making deep cuts to the overall HHS budget.
According to the administration's budget blueprint, the HFCAC program returned $5 for every $1 spent between 2014 and 2016. A health-care attorney based in San Francisco told Bloomberg BNA said that the HCFAC not only has returned on investment in dollars and cents, but also has been successful in deterring health care fraud in general.
If Medicare changes, will enforcement change too?
Some in heath care law are skeptical of the future of the HFCAC program, though. A Washington-based health-care attorney told Bloomberg BNA that changes to the Medicaid program overall, which have been proposed by the American Health Care Act, could hinder Medicaid fraud enforcement efforts. You can read more on this point here.
Ultimately, while questions still remain, one thing for certain is that the new administration is once again placing an emphasis on the HFCAC program and health care fraud enforcement. That means health care providers must make every effort to ensure that they are in compliance with the law.
If you are under investigation for health care fraud
Anytime health care providers find themselves under investigation for alleged health care fraud, they will need to work with an attorney immediately to protect themselves. Health care fraud is prosecuted aggressively, whether providers were intentionally breaking the law or not.