In FY 2020, the Department of Justice (DOJ) opened 1,148 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants.
A total of 440 defendants were convicted of healthcare fraud related crimes during the year.
Also, in FY 2020, DOJ opened 1,079 new civil healthcare fraud investigations and had 1,498
civil healthcare fraud matters pending at the end of the fiscal year. Federal Bureau of
Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal
fraud organizations and the dismantlement of the criminal hierarchy of more than 101 healthcare
fraud criminal enterprises.
In FY 2020, investigations conducted by HHS’s Office of Inspector General (HHS-OIG) resulted
in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare
and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits
filed in federal district court, civil monetary penalties (CMP) settlements, and administrative
recoveries related to provider self-disclosure matters. HHS-OIG also excluded 2,148 individuals
and entities from participation in Medicare, Medicaid, and other federal healthcare programs.
Among these were exclusions based on criminal convictions for crimes related to Medicare and
Medicaid (891) or to other healthcare programs (316), for patient abuse or neglect (230), and as a result of state healthcare licensure revocations (509). HHS-OIG also issued numerous audits
and evaluations with recommendations that, when implemented, would correct program
vulnerabilities and save Medicare and Medicaid funds.
