OIG: Tougher 2016 probes

Providers should expect more aggressive federal efforts to investigate healthcare fraud cases as the Department of Health & Human Services makes use of sophisticated data analytics in the coming year.

Agents will be dispatched to cases with the greatest prosecution potential, the department's Inspector General warned near press time. And for the first time, the agency plans to go after more individuals, in addition to corporations, officials said.

OIG plans to increase the number of new cases it opens involving exclusions and civil monetary penalties, said OIG Chief Counsel Gregory Demske in published reports.

The agency resolved 110 such cases in the past fiscal year. Hints of the heightened investigative efforts came in June when HHS recruited and added a team of attorneys focused exclusively on OIG-initiated litigation.

Demske explained the approach during a Health Care Compliance Association's Healthcare Enforcement Compliance Institute conference in late October.

In September, Deputy Attorney General Sally Quillian Yates proposed the plan to hold more individuals responsible in fraud cases while encouraging greater collaboration among civil and criminal prosecutors. OIG officials say they are hopeful more overt efforts will encourage providers to self-disclose more.