Medicare:

Health Care Fraud and Abuse Control Program for Fiscal Years 2000 and 2001

GAO-02-731: Published: Jun 3, 2002. Publicly Released: Jun 3, 2002.

Additional Materials:

Contact:

Linda M. Calbom
(202) 512-8341
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

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.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To facilitate providing Congress and other decision makers with relevant information on program performance and results, the Attorney General and the Secretary of Health and Human Services should assess the feasibility of tracking cost savings and expenditures attributable to HCFAC activities by the various federal programs affected.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: This recommendation is no longer applicable.

    Recommendation: To improve DOJ's accountability for the HCFAC program expenditures, the Attorney General should reinforce financial management policies and procedures to minimize errors in recording HCFAC transactions.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: DOJ officials stated that the Department is continuing its ongoing financial management training efforts to reinforce the importance of accurate financial management processing and the minimization of data entry and errors. DOJ provided documentation to support the following training efforts: In the last 6 months, the Department has conducted two Appropriations Law training sessions, four classes on proper recording and classification of obligations, six classes on proper entry of intragovernmental obligations, and four classes on electronic submission of intragovernmental earnings data. Also, the issue is also emphasized in monthly Financial Managers Council meetings and "clean audit" training.

    Recommendation: To improve DOJ's accountability for the HCFAC program expenditures, the Attorney General should make correcting adjustments for expenditures improperly charged to the HCFAC appropriation.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: DOJ officials have corrected both the misposted non-HCFAC charge, along with the Health Care Fraud and Abuse Control (HCFAC) charge that was posted to another account, charging them to their proper obligations and appropriations in the Financial Management Information System.

    Recommendation: To improve DOJ's accountability for the HCFAC program collections, the Attorney General should ensure that subsequent collection reports submitted to the Department of the Treasury are accurate.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: As GAO recently reported as part of its review of fiscal years 2002 and 2003 HCFA activities (see GAO-05-134), DOJ developed and implemented new procedures for reviewing collections reports for accuracy and approving them prior to submission to BPD.

    Recommendation: To improve DOJ's accountability for the HCFAC program collections, the Attorney General should fully implement plans to make all necessary correcting adjustments for collections transferred to the trust fund in error.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: As GAO recently reported as part of its review of fiscal years 2002 and 2003 HCFA activities (see GAO-05-134), DOJ determined the amount of the overstatement in its reporting of HCFAC collections and submitted an adjustment to the Bureau of Public Debt (BPD) in September 2002. However, in its review of the supporting documentation, GAO identified a mathematical error in DOJ's calculations. DOJ agreed with the revised amount and submitted the adjustment to BPD in September 2004.

    Recommendation: To facilitate providing Congress and other decision makers with relevant information on program performance and results, the Attorney General and the Secretary of Health and Human Services should assess the feasibility of tracking cost savings and expenditures attributable to HCFAC activities by the various federal programs affected.

    Agency Affected: Department of Justice

    Status: Closed - Implemented

    Comments: This recommendation is no longer applicable.

    Jul 29, 2014

    Jul 23, 2014

    Jul 16, 2014

    Jul 15, 2014

    Jul 10, 2014

    Jun 30, 2014

    Jun 25, 2014

    Jun 24, 2014

    Jun 23, 2014

    Looking for more? Browse all our products here