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Medicare Fraud and Abuse: DOJ Has Improved Oversight of False Claims Act Guidance

NCJ Number
Date Published
March 2001
16 pages
This report concerns the use of the False Claims Act in civil health care fraud.
The U.S. Department of Justice [DOJ] has taken steps to further strengthen its oversight of compliance with its False Claims Act guidance. DOJ's review of each U.S. Attorney's Office's compliance with the guidance now appears to be an integral part of the periodic evaluations it makes of all US Attorneys' Offices. Also, DOJ's annual requirement that all U.S. Attorneys' Offices involved in civil health care fraud control certify their compliance with the guidance appears to have promoted compliance in offices visited by General Accounting Office evaluators. Those offices had either documented their compliance in case files or instituted a review process under the direction of their office's Civil Chief. The working groups continue to coordinate national initiatives and maintain ongoing contacts with participating U.S. Attorneys' Offices to determine whether they are complying with the guidance. DOJ is implementing its two most recent and active national initiatives - the PPS Transfer and Pneumonia Upcoding projects - in a manner consistent with the guidance. The hospital association continues to be concerned about the appropriateness of DOJ's use of the False Claims Act in civil health care matters, but has not identified specific examples of noncompliance with the guidance among US Attorneys' Offices. Abbreviations, notes, appendix