Medicare Fraud and Abuse

In June 1998, The Department of Justice (DOJ) issued guidance on the fair and responsible use of the False Claims Act in civil health care matters. This report evaluates DOJ's efforts to ensure compliance with the guidance and focuses on the application of the guidance in two recent DOJ initiatives-the Prospective Payment System (PPS) Transfer and Pneumonia Upcoding Project. GAO found that DOJ has taken steps to further strengthen its oversight of compliance with its False Claims Act guidance. These steps include (1) reviewing each U.S. Attorneys Office's compliance with the guidance as part of the periodic evaluation of all U.S. Attorneys' Offices, (2) requiring all U.S. Attorneys' Offices involved in civil health care fraud control to certify their compliance with the guidance, (3) forming working groups to coordinate national initiatives, and (4) maintaining ongoing contacts with participating U.S. Attorneys' Offices to help ensure that they are complying with the guidance. GAO also found that DOJ is implementing the PPS Transfer and Pneumonia Upcoding projects in a manner consistent with the guidance.