Medicare

Health Care Fraud and Abuse Control Program for Fiscal Years 2000 and 2001 Gao ID: GAO-02-731 June 3, 2002

The Medicare program is the nation's largest health insurer with almost 40 million beneficiaries and outlays of over $219 billion annually. Because of the susceptibility of the program to fraud and abuse, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) Program as part of the Health Insurance Portability and Accountability Act (HIPPAA) of 1996. HCFAC, which is administered by the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) and the Department of Justice (DOJ), established a national framework to coordinate federal, state, and local law enforcement efforts to detect, prevent, and prosecute health care fraud and abuse in the public and private sectors. HIPPAA requires HHS and DOJ to issue a joint annual report no later than January 1 of each year to Congress for the proceeding fiscal year. The joint HCFAC reports included deposits of $210 million for fiscal year 2000 and $464 million for fiscal year 2001, pursuant to the act. In testing at DOJ, GAO found errors in the recording of criminal fines deposits to the Federal Hospital Insurance Trust Fund in fiscal year 2001 that resulted in an estimated overstatement to the trust fund of $169,765. GAO found that the planned use of HCFAC appropriations was in keeping with the stated purpose in the act. Although GAO found expenditures from the trust fund were generally appropriate at HHS, at DOJ GAO found $480,000 in interest penalties not related to HCFAC activities that were charged to the HCFAC appropriation. GAO was unable to identify expenditures from the HCFAC trust fund for activities unrelated to Medicare because the HHS/OIG and DOJ do not separately account for or monitor these activities. Likewise, GAO was unable to identify savings specifically attributable to activities funded by the HCFAC program.

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