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"The health care anti-fraud landscape is critically different today than in the very recent past. Health care fraud is higher on the list of priorities for federal law enforcement. Cases like the ongoing Columbia/HCA investigation and the recent SmithKline Beecham government settlement demonstrate the power and monetary impact of active fraud investigations. To assist in this battle, recent legislation provides new law enforcement investigative tools and additional resources. Within this landscape of aggressive, coordinated anti-fraud activity, managed care has created a wildly changed health care market place structure in which to fight fraud. Legislation and this new business environment also have created substantial new opportunities for payers with aggressive fraud-fighting skills. And the expanded emphasis on fraud-fighting at all levels of law enforcement also means new risks for payers in conducting their primary business activities.

What do all these developments mean for payers? My goals in these materials is to provide information on the current developments in traditional fraud-fighting activity, and also to raise awareness of new areas where fraud activities should be integrated with ongoing business operations. On the whole, these developments mean that much broader attention should be paid to anti-fraud activities, because the impact of fraud affects such a wide range of payer business activities."

Article: New Anti-Fraud Challenges for Health Care Payers

© 1998 Kirk J. Nahra

Wiley, Rein & Fielding

Even these steps, if successfully implemented, will not insulate Columbia/HCA from the expansive scope of the Federal Anti-Kickback Statute (42 U.S.C. §1320a-7b(b)) and the Federal Anti-Referral Law commonly known as "Stark" (42 U.S.C. §1395nn)."

Article: Submerged Safe Harbors Against Stark Attacks

© 1997 Scott C. Withrow.

Withrow, McQuade & Olsen

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Don't believe there's really much fraud in health care? Check out these DOJ and OIG press releases on fraud settlements for late 1996 and 1997, learn more about Operation Restore Trust, or view the GAO reports on fraud and abuse. And they're just getting started!

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The Clinton Administration awarded more than $2.25 million in grants for new programs to complement Medicare's ongoing anti-fraud efforts. The grants were funded pursuant to the Health Insurance Portability and Accountability Act (HIPAA). These funds are in addition to over $1 billion appropriated to HHS, FBI and OIG over the next five years to combat health care fraud and abuse. The grants are being distributed to nine state agencies (Alabama, California, Colorado, Nebraska, New York, North Carolina, Pennsylvania, Tennesee and Wisconsin), the District of Columbia, the Department of Defense, and the Internal Revenue Service. The grants will cover the cost of audits, inspections, equipment, provider evaluations, investigations, prosecutions and consumer education.

An additional 15 anti-fraud grants totaling $750,000, will be administered through state offices on aging in Arizona, Colorado, California, Florida, Georgia, Illinois, Massachusetts, Missouri, New York, Ohio, Pennsylvania, Texas, Tennesee, Virginia and Washington. See Clinton Administration Releases Grants to Fight Fraud and Abuse

"GAO estimates that fraud and abuse in the health care industry accounts for an estimated 10 percent of our yearly private and public expenditures. In 1994, this would have approached $94 billion. That amounts to approximately $258 million a day or $11 million every single hour."

--Hon. Fortney Pete Stark, June 22, 1995, Cong.Rec. Page E1309 (Introducing HR 1912, Health Care Fraud Prevention and Paperwork Reduction Act of 1995 (a bill to deter and penalize health care fraud and abuse and to simplify the administration of health benefit plans)). Summary of fraud and abuse provisions in the Health Insurance Portability and Accountability Act.

• 18 USC Sec. 287. False, fictitious or fraudulent claims
• 31 USC Secs. 3729 to 3732, (The Federal False Claims Act)
  • 31 USC Sec. 3729
  • 31 USC Sec. 3730
  • 31 USC Sec. 3731
  • 31 USC Sec. 3732
• 42 USC Sec. 1320a-7. Exclusion of certain individuals and entities from participation in Medicare
• 42 USC Sec. 1320a-7a. Civil monetary penalties
• 42 USC Sec. 1320a-7b. Criminal penalties for acts involving Medicare
• 42 USC Sec. 1395nn. Limitation on certain physician referrals

• Sec. 200. References in title.

• Subtitle A--Fraud and Abuse Control Program
  • Sec. 201. Fraud and abuse control program.
  • Sec. 202. Medicare integrity program.
  • Sec. 203. Beneficiary incentive programs.
  • Sec. 204. Application of certain health antifraud and abuse sanctions to fraud and abuse against Federal health care programs.
  • Sec. 205. Guidance regarding application of health care fraud and abuse sanctions.
• Subtitle B--Revisions to Current Sanctions for Fraud and Abuse
  • Sec. 211. Mandatory exclusion from participation in Medicare and State health care programs.
  • Sec. 212. Establishment of minimum period of exclusion for certain individuals and entities subject to permissive exclusion from Medicare and State health care programs.
  • Sec. 213. Permissive exclusion of individuals with ownership or control interest in sanctioned entities.
  • Sec. 214. Sanctions against practitioners and persons for failure to comply with statutory obligations.
  • Sec. 215. Intermediate sanctions for Medicare health maintenance organizations.
  • Sec. 216. Additional exception to anti-kickback penalties for risk- sharing arrangements.
  • Sec. 217. Criminal penalty for fraudulent disposition of assets in order to obtain Medicaid benefits.
  • Sec. 218. Effective date.
• Subtitle C--Data Collection
  • Sec. 221. Establishment of the health care fraud and abuse data collection program.
  • Subtitle D--Civil Monetary Penalties
  • Sec. 231. Social Security Act civil monetary penalties.
  • Sec. 232. Penalty for false certification for home health services.
• Subtitle E--Revisions to Criminal Law
  • Sec. 241. Definitions relating to Federal health care offense.
  • Sec. 242. Health care fraud.
  • Sec. 243. Theft or embezzlement.
  • Sec. 244. False statements.
  • Sec. 245. Obstruction of criminal investigations of health care offenses.
  • Sec. 246. Laundering of monetary instruments.
  • Sec. 247. Injunctive relief relating to health care offenses.
  • Sec. 248. Authorized investigative demand procedures.
  • Sec. 249. Forfeitures for Federal health care offenses.
  • Sec. 250. Relation to ERISA authority.

TITLE IV--MEDICARE, MEDICAID, AND CHILDREN'S HEALTH PROVISIONS

Subtitle D--Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity

• Chapter 1--Revisions To Sanctions for Fraud and Abuse
  • Sec. 4301. Permanent exclusion for those convicted of 3 health care related crimes.
  • Sec. 4302. Authority to refuse to enter into medicare agreements with individuals or entities convicted of felonies.
  • Sec. 4303. Exclusion of entity controlled by family member of a sanctioned individual.
  • Sec. 4304. Imposition of civil money penalties.
• Chapter 2--Improvements In Protecting Program Integrity
  • Sec. 4311. Improving information to medicare beneficiaries.
  • Sec. 4312. Disclosure of information and surety bonds.
  • Sec. 4313. Provision of certain identification numbers.
  • Sec. 4314. Advisory opinions regarding certain physician self-referral provisions.
  • Sec. 4315. Replacement of reasonable charge methodology by fee schedules.
  • Sec. 4316. Application of inherent reasonableness to all part B services other than physicians' services.
  • Sec. 4317. Requirement to furnish diagnostic information.
  • Sec. 4318. Report by GAO on operation of fraud and abuse control program.
  • Sec. 4319. Competitive bidding demonstration projects.
  • Sec. 4320. Prohibiting unnecessary and wasteful medicare payments for certain items.
  • Sec. 4321. Nondiscrimination in post-hospital referral to home health agencies and other entities.
• Chapter 3--Clarifications And Technical Changes
  • Sec. 4331. Other fraud and abuse related provisions.

• Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (Federal Register: January 9, 1998 (Volume 63, Number 6)). If a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services under the Medicare program, unless certain exceptions apply.
• Privacy Act of 1974; Altered System of Records [National Practitioner Data Bank], [Federal Register: March 17, 1997 (Volume 62, Number 51)] [Notices] [Page 12653-12656]. A proposal to add a new category of records to the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners. HRSA proposes to add specific information on physicians, practitioners, providers, and other health care entities which the Office of Inspector General (OIG), HHS has excluded from participation in and from recovering payment from the Medicare and Medicaid programs.
• Health Care Programs, Fraud and Abuse; Intent To Form the Negotiated Rulemaking Committee for the Shared Risk Exception, [Federal Register: May 23, 1997 (Volume 62, Number 100)] [Proposed Rules] [Page 28410-28413]. We have been statutorily-mandated under section 216 of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, to establish a negotiated rulemaking committee in accordance with the Negotiated Rulemaking Act and the Federal Advisory Committee Act (FACA).
• Medicare and State Health Care Programs: Fraud and Abuse; Issuance of Advisory Opinions by the OIG, [Federal Register: February 19, 1997 (Volume 62, Number 33)] [Rules and Regulations] [Page 7350-7360]. In accordance with section 205 of the Health Insurance Portability and Accountability Act of 1996, this final rule establishes a new part 1008 in 42 CFR chapter V to address the new OIG advisory opinion process.
• Publication of the OIG Model Compliance Plan for Clinical Laboratories, [Federal Register: March 3, 1997 (Volume 62, Number 41)] [Notices] [Page 9435-9441]. This Federal Register notice sets forth the recently issued model compliance plan for clinical laboratories developed by the Office of Inspector General in cooperation with, and input from, several provider groups and industry representatives.
• Health Care Programs: Fraud and Abuse; Revised PRO Sanctions for Failing To Meet Statutory Obligations, [Federal Register: April 29, 1997 (Volume 62, Number 82)] [Rules and Regulations] [Page 23140-23144]. This final rule addresses revised procedures governing the imposition and adjudication of program sanctions, based on recommendations from State utilization and quality control peer review organizations (PROs), resulting from enactment of sections 214 and 231(f) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
• Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies, [Federal Register: March 10, 1997 (Volume 62, Number 46)] [Proposed Rules] [Page 11005-11035]. This proposed rule revises the existing conditions of participation that home health agencies must meet to participate in the Medicare program.
• Medicare Program; Changes Concerning Suspension of Medicare Payments, and Determinations of Allowable Interest Expenses, 61FR63740 (December 2, 1996)
• Publication of OIG Special Fraud Alert: Fraud and Abuse in the Provision of Services in Nursing Facilities, 61FR30623 (June 17, 1996)
• Office of Inspector General; Statement of Organization, Functions and Delegations of Authority, 61FR22059 (May 13, 1996)
• Medicare and State Health Care Programs: Fraud and Abuse; Safe Harbors for Protecting Health Plans, 61FR2122 (January 25,1996)
• Publication of OIG Special Fraud Alerts: Home Health Fraud, and Fraud and Abuse in the Provision of Medical Supplies to Nursing Facilities, 60FR40847 (August 10, 1995)
• Publication of OIG Special Fraud Alerts, FR Doc. 94-31157 (December 19, 1994)

• 42 CFR PART 411 - EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
  • 42 CFR Sec. 411.1 Basis and scope
  • 42 CFR Sec. 411.15 Particular services excluded from coverage.
  • 42 CFR Sec. 411.408 Refunds of amounts collected for physician services
  • 42 CFR Sec. 411.33 Amount of Medicare secondary payment.
  • 42 CFR Sec. 411.47 Apportionment of a lump-sum compromise settlement of a
  • 42 CFR Sec. 411.72 Medicare benefits secondary to employer group health
• 42 CFR Parts 417, 431, 434, and 1003 Civil Money Penalties and Intermediate Sanctions for Certain Violations by Health Maintenance Organizations and Competitive Medical Plans
• 42 CFR PART 455 - PROGRAM INTEGRITY: MEDICAID
  • Sec. 455.1 Basis and scope.
  • Sec. 455.2 Definitions
  • Sec. 455.3 Other applicable regulations
  • Sec. 455.12 State plan requirement
  • Sec. 455.13 Methods for identification, investigation, and referral
  • Sec. 455.14 Preliminary investigation
  • Sec. 455.16 Resolution of full investigation
  • Sec. 455.17 Reporting requirements
  • Sec. 455.18 Provider's statements on claims forms
  • Sec. 455.19 Provider's statement on check
  • Sec. 455.20 Recipient verification procedure
  • Sec. 455.21 Cooperation with State Medicaid fraud control units
  • Sec. 455.23 Withholding of payments in cases of fraud
  • Sec. 455.100 Purpose
  • Sec. 455.101 Definitions
  • Sec. 455.102 Determination of ownership or control percentages
  • Sec. 455.103 State plan requirement
  • Sec. 455.104 Information on ownership and control
  • Sec. 455.105 Information related to business transactions
  • Sec. 455.106 Information on persons convicted of crimes
• 42 CFR 1003 Civil Money Penalties for Referrals to Entities and for Prohibited Arrangements and Schemes
• 42 CFR Part 1004 Revisions to the PRO Sanctions Process
• 42 CFR 1001 Medicare and State Health Care Programs: Fraud and Abuse; Clarification of the OIG Safe Harbor Anti-Kickback Provisions

• PREVALENCE OF HEALTH CARE FRAUD AND ABUSE Vladeck Testimony. The implementation of HIPAA has given us powerful weapons against waste, fraud, and abuse. The work of this Committee and other Members of Congress on HIPAA has been vital to this important legislation, which will increase our ability to protect the integrity of the Medicare program, and to safeguard the interests of our beneficiaries.
• Congressional Record 1997: Fraud & Abuse
• Health Fraud Bills (105th Congress)
• Search "Health Fraud"
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• Erickson v. U.S. (9th Cir., October 5, 1995) (Medicare exclusion while defendants await appeal in fraud case)

• Health Care Fraud Prevention and Detection:Technical Advisory Group White Paper. Health care fraud schemes range from those committed by individual providers and/or consumers acting alone, to broad-based operations conceived for the purpose of committing fraud.
• Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies. HEHS-98-29. 31 pp. plus 3 appendices (17 pp.) December 16, 1997.
• Medicare Home Health Benefit: Congressional and HCFA Actions Begin to Address Chronic Oversight Weaknesses. T-HEHS-98-117. 12 pp. March 19, 1998.
• Medicare: Improper Activities by Mid-Delta Home Health. T-OSI-98-6. 9 pp. plus 1 appendix (1 pp.) March 19, 1998.
• Health Care Fraud: Information-Sharing Proposals to Improve Enforcement Efforts (Chapter Report, 05/01/96, GAO/GGD-96-101). GAO discussed: (1) the extent of federal and state immunity laws protecting persons who report health care fraud; and (2) evidence for and against establishing a centralized health care fraud database.
• Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities (Letter Report, 01/24/96, GAO/HEHS-96-18). GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients.
• Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers (Testimony, 11/02/95, GAO/T-HEHS-96-7). GAO discussed challenges Medicare faces in battling fraud and abuse in the health care system.
• Medicare: Antifraud Technology Offers Significant Opportunity to Reduce Health Care Fraud (Letter Report, 08/11/95, GAO/AIMD-95-77). Pursuant to a congressional request, GAO provided information on how the Medicare program detects and prevents fraud.
• Health Care Fraud: Information-Sharing Proposals to Improve Enforcement Efforts (Chapter Report, 05/01/96, GAO/GGD-96-101). Pursuant to a congressional request, GAO discussed: (1) the extent of federal and state immunity laws protecting persons who report health care fraud; and (2) evidence for and against establishing a centralized health care fraud database.
• Medicare: New Claims Processing System Benefits and Acquisition Risks (Letter Report, 01/25/94, GAO/HEHS/AIMD-94-79). A new system for processing Medicare claims offers considerable opportunities to improve Medicare operations and safeguard program dollars.
• Medicare Transaction System: Success Depends Upon Correcting Critical Managerial and Technical Weaknesses (Chapter Report, 05/16/97,GAO/AIMD-97-78). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) acquisition of its Medicare Transaction System.
• Medicare: Greater Investment in Claims Review Would Save Millions (Letter Report, 03/02/94, GAO/HEHS-94-35). Given soaring U.S. health care costs and shrinking budgets for many government programs, Congress is concerned that Medicare pay only for appropriate medical services without compromising the quality of care provided to beneficiaries.
• Medicare: Inadequate Review of Claims Payments Limits Ability to Control Spending (Letter Report, 04/28/94, GAO/HEHS-94-42). Medicare overpayments of millions of dollars are being made because of inadequate safeguards by contractors who process Medicare claims and inattention by the federal Health Care Financing Administration
• Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes (Letter Report, 03/30/95, GAO/HEHS-95-23). Nursing homes and rehabilitation centers are taking advantage of ambiguous payment rules and lack of guidelines to bill Medicare at inflated rates for therapy services.
• Medicare: Excessive Payments for Medical Supplies Continue Despite Improvements (Letter Report, 08/08/95, GAO/HEHS-95-171). In fiscal year 1994 alone, Medicare was billed over $6.8 billion for medical supplies.
• Medicare Spending: Modern Management Strategies Needed to Curb Billions in Unnecessary Payments (Letter Report, 09/19/95, GAO/HEHS-95-210). Pursuant to a congressional request, GAO examined Medicare's vulnerability to provider exploitation and ways to remedy Medicare fraud and abuse.
• Medicare: Home Health Utilization Expands While Program Controls Deteriorate (Letter Report, 03/27/96, GAO/HEHS-96-16). Pursuant to a congressional request, GAO examined the growth in the use of Medicare home health benefits.
• Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities (Letter Report, 01/24/96, GAO/HEHS-96-18). Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients.
• Medicare: Millions Can Be Saved by Screening Claims for Overused Services (Letter Report, 01/30/96, GAO/HEHS-96-49). GAO provided information on Medicare payments for unnecessary medical services.
• Medicare: Private Payer Strategies Suggest Options to Reduce Rapid Spending Growth (Testimony, 04/30/96, GAO/T-HEHS-96-138). GAO discussed strategies to curb Medicare spending, which has grown by over 10 percent a year since 1989, twice the rate of the national economy.
• Medicare: Early Resolution of Overcharges for Therapy in Nursing Homes is Unlikely (Letter Report, 08/16/96, GAO/HEHS-96-145). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) progress in curbing overbilling for occupational speech and physical therapy services.
• Fraud and Abuse: Providers Excluded From Medicaid Continue to Participate in Federal Health Programs (Testimony, 09/05/96, GAO/T-HEHS-96-205). GAO discussed whether the Department of Health and Human Services' (HHS) Office of Inspector General's (OIG) process for removing fraudulent health care providers from all federal health programs.
• Medicare HMOs: HCFA Can Promptly Eliminate Hundreds of Millions in Excess Payments (Letter Report, 04/25/97, GAO/HEHS-97-16). Pursuant to a congressional request, GAO provided information on Medicare's rate-setting method for paying risk contract health maintenance organizations.
• Medicaid Fraud and Abuse: Stronger Action Needed to Remove Excluded Providers From Federal Health Programs (Letter Report, 03/31/97, GAO/HEHS-97-63). Pursuant to a congressional request, GAO reviewed the Department of Health and Human Services (HHS) Inspector General's (OIG) process for excluding providers from federal health care programs.
• Medicare: Need to Hold Home Health Agencies More Accountable for Inappropriate Billings (Letter Report, 06/13/97, GAO/HEHS-97-108). Pursuant to a congressional request, GAO reviewed Medicare's ability to detect and prevent inappropriate payments to home health agencies.
• Nursing Homes: Too Early to Assess New Efforts to Control Fraud and Abuse (Testimony, 04/16/97, GAO/T-HEHS-97-114). GAO discussed the challenges that exist in combating fraud and abuse in the nursing facility environment.
• Medicare: Allegations Against ABC Home Health Care (Letter Report, 07/19/95, GAO/OSI-95-17). In response to a congressional request, GAO investigated allegations against ABC Home Health Care, a home health agency (HHA), and its participation in the Medicare home health care program.
• Electronic Benefits Transfer: Use of Biometrics to Deter Fraud in the Nationwide EBT Program (Letter Report, 09/29/95, GAO/OSI-95-20). The National Performance Review recommended in 1993 that the federal government consider paying individuals by using electronic rather than paper means.
• Investigators' Guide to Sources of Information (Other Written Prod., 04/01/97, GAO/OSI-97-2). GAO presented an investigative tool for identifying sources of information about people, property, business, and finance.
• Medicare Claims Billing Abuse: Commercial Software Could Save Hundreds of Millions Annually (Testimony, 05/05/95, GAO/T-AIMD-95-133). With an investment of only $20 million in off-the-shelf commercial software, Medicare could save nearly $4 billion over five years by detecting fraudulent claims by physicians--primarily manipulation of billing codes.
• Medicare: Modern Management Strategies Could Curb Fraud, Waste, and Abuse (Testimony, 07/31/95, GAO/T-HEHS-95-227). Medicare's vulnerability to waste, fraud, and abuse stems from several factors.
• Medicare: Excessive Payments for Medical Supplies Continue Despite Improvements (Testimony, 10/02/95, GAO/T-HEHS-96-5). GAO discussed Medicare payments for medical supplies.
• Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers (Testimony, 11/02/95, GAO/T-HEHS-96-7). GAO discussed challenges Medicare faces in battling fraud and abuse in the health care system
• Medicare Claims: Commercial Technology Could Save Billions (Letter Report, 05/05/95, GAO/AIMD-95-135). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) potential use of commercial technology to detect Medicare billing errors.
• Health Care Fraud: Information-Sharing Proposals to Improve Enforcement Efforts (Chapter Report, 05/01/96, GAO/GGD-96-101). Pursuant to a congressional request, GAO discussed: (1) the extent of federal and state immunity laws protecting persons who report health care fraud; and (2) evidence for and against establishing a centralized health care fraud database.
• Medicare: New Claims Processing System Benefits and Acquisition Risks (Letter Report, 01/25/94, GAO/HEHS/AIMD-94-79). A new system for processing Medicare claims offers considerable opportunities to improve Medicare operations and safeguard program dollars.
• High Risk Series: Medicare Claims [HR-95-8]
• U.S. Attorneys: More Accountability [GGD-95-150]
• Medicaid: A Program Highly Vulnerable to Fraud [T-HEHS-94-106]

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  Operation Restore Trust

• DOJ: 2-24-97 - DOJ and HHS Highlight Latest Efforts to Fight Fraud by Clinical Laboratories
• DOJ: 3-06-97 - Statement by AG Reno on Health Care Fraud
• The Medicare Integrity Program Hmm...might be worth checking out.
• HCFA: Expanded Operation Restore Trust
• HHS: Clinton Administration Releases Grants to Fight Fraud and Abuse
• HHS: Medicare Fraud Hotline Improved and Expanded
• HHS: Operation Restore Trust Accomplishments
• HCFA: Fraud & Home Medical Equipment
• HCFA: Physician Incentive Regulation
• Medicaid Fraud and Abuse Information

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  DOJ/OIG Press Releases: Fraud Settlements

• OIG: 12-18-96 - Spectra Laboratories agreed to pay $10.1 million to resolve civil liability under the False Claims Act, the Civil Monetary Penalties Law and the Medicare/Medicaid Anti-Kickback Law.
• OIG: 11-21-96 - Laboratory Corporation of America (LabCorp) has agreed to pay $182 million to resolve civil liabilities associated with submitting false claims for medically unnecessary laboratory tests.
• OIG: 1-23-97 - Horizon/CMS Healthcare Corporation has paid a total of $5.8 million to resolve civil liability for false claims.
• DOJ: 2-12-97 - California Health Lab Pays U.S. $5.2 Million for Medicare Fraud
• DOJ: 2-11-97 - U.S. Gets $750,000 for Fraud Claims Against Oklahoma Hospital
• DOJ: 2-14-97 - Four Health Care Groups Pay U.S. over $2 Million for Fraud
• OIG: 2-26-97 - Clinical Laboratory Agrees to Pay $325 Million to Settle False Medicare Claims
• OIG: 3-27-97 - Mental Health Care Executive Pled Guilty in Medicare Fraud Scheme
• DOJ: 4-10-97 - New Jersey Drug Firm and Owner Sentenced and Fined In Illegal Pharmaceutical and Money Laundering Scheme
• OIG: 4-14-97 - Chiropractor Sentenced in Fraud Scheme
• OIG: 4-15-97 - Psychologist Convicted of Defrauding Medicare of $2.5 Million
• DOJ: 5-23-97 - Texas Firm Will Pay U.S. $1.3 Million to Settle Fraud Case in Continuing Federal Investigation of Health Pump Industry
• DOJ: 5-21-97 - Emcare Inc. To Pay U.S. and States $7.75 Million For Health Care Billing Fraud, Start Integrity Program
• DOJ: 5-05-97 - Four Firms Will Pay U.S. $12 Million to Settle Health Care Claims
• DOJ: 5-02-97 - Department of Justice Settles Whistleblower Lawsuit Against Blue Shield of California for 12 Million Dollars
• DOJ: 6-17-97 - National Laboratory Pays U.S. $700,000 for Medicare Fraud
• OIG: 7-29-97 - Hospital Firm Pays $12.6 Million to Settle Kickback Allegations
• DOJ: 8-01-97 -Vendell Healthcare, Inc. To Settle with U.S. and Nebraska for $1.3 Million for Overbilling Medicaid

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