[ Wednesday, May 19, 2004 ]


More government resources means more likely HIPAA enforcement? Speaking recently at the American Bar Association Health Care Fraud 2004 conference, the chief deputy director of the Department of Justice's criminal fraud section noted that the influx of resources brought about by the passage of HIPAA has greased the wheels of the DOJ's fraud unit, which has dramatically increased its various healthcare fraud investigations. Of course, the majority of these involve payment fraud and things like internet pharmacies. Additionally, the influx of money expected under the new Medicare prescription drug provisions (as well as the ever-increasing amount Americans pay for prescription drugs) look like a tempting fraud magnet.

However, the additional governmental resources provided, plus the dramatic amount of money brought back into the system through enforcement actions ($4 billion in governmental fraud prosecution recoveries just since HIPAA came into existence), have given the government a new bank book with which to launch fraud prosecutions.

I'd expect that most of these will involve new federal programs like the prescription drug program (fraudsters tend to hit new programs first, believing that they can get money out of them before the regulators figure out how to catch them or where the loose spigots are), or will involve technological issues like internet pharmacies or other telemedicine (since the facelessness of the internet makes it a great place to pull off a scam). However, HIPAA covered entities should take care, since there is a large overlap between the "technology" part of fraud investigations and the technological impacts of HIPAA. Additionally, expect HIPAA to be added on to other charges, sort of like "aiding and abetting" or "conspiracy" charges are now added to any federal fraud charge.

Most importantly, keep in mind that the government has funds to chase down fraud, and is looking at HIPAA as a charging element. And where the government has money to carry out prosecutions, they'll carry out prosecutions; don't be a target.

Jeff [11:33 AM]

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