United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-08-06 monographic deposited born digital 33 p. GA 1.13:HEHS-99-170 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-170 P0b002ee1803981dd f:he99170 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-99-170 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-170 HEHS-99-170 Hospitals Claims processing Medical expense claims Overpayments Health insurance cost control Program abuses Investigations by federal agencies Internal controls Medicare Prospective Payment System DOJ/HHS Laboratory Unbundling Project Medicare Program DOJ/HHS 72 Hour Window Project Letter Report HEHS

Pursuant to a legislative requirement, GAO reviewed the Department of Justice's (DOJ) and selected U.S. Attorneys' Offices' implementation of the False Claims Act guidance, focusing on: (1) the status of DOJ's work groups efforts and the initiative-specific guidance they prepared; (2) DOJ's efforts to assess U.S. Attorneys' compliance with the guidance; (3) the implementation of the guidance at selected U.S. Attorneys' Offices; and (4) state hospital associations' concerns regarding DOJ's use of the False Claims Act.<p/>GAO noted that: (1) DOJ's national initiative work groups have made further progress in implementing the Department's False Claims Act guidance since GAO issued its February 1, 1999, report; (2) all four work groups have completed their examination of the legal and factual basis for their initiatives and have prepared initiative-specific guidance for the U.S. Attorneys' Offices participating in the initiatives; (3) the guidance prepared by these work groups is consistent with the requirements in DOJ's guidance; (4) while DOJ officials told GAO compliance with its False Claims Act guidance is an ongoing priority for the Department, GAO believes DOJ's process for assessing the U.S. Attorneys' Offices' compliance may be superficial; (5) these assessments appear to involve little more than reviewers asking supervisors what they have done to ensure compliance with the guidance; (6) DOJ's plans for strengthening the assessment process, such as adding more questions, may not be enough to effectively assess compliance; (7) in GAO's view, these additional questions will not provide more substantive information than the original question and are only a starting point for an effective assessment; (8) GAO also found that the implementation of DOJ's False Claims Act guidance varied among the eight U.S. Attorneys' Offices GAO visited that were participating in the national initiatives; (9) five of these offices were participating in the Laboratory Unbundling initiative and had begun their involvement before DOJ's guidance was issued; (10) GAO found that their actions were, to varying degrees, inconsistent with the guidance; (11) GAO's limited review also raised questions about whether four of these offices were promptly incorporating the guidance into their ongoing investigations; (12) restrictions on GAO's access at all offices prevented GAO from conducting a complete and independent review; (13) GAO's survey of state hospital associations indicated that the issuance of DOJ's False Claims Act guidance has lessened their concerns about national initiative investigations; and (14) half of the associations expressing concerns with DOJ's use of the False Claims Act prior to the issuance of the guidance said that the guidance had fully addressed their concerns. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-170/html/GAOREPORTS-HEHS-99-170.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-170/pdf/GAOREPORTS-HEHS-99-170.pdf GAO/HEHS-99-170 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-170 Letter Report GAO/HEHS-99-170; Medicare Fraud and Abuse: DOJ's Implementation of False; Hospitals Claims processing Medical expense claims Overpayments Health insurance cost control Program abuses Investigations by federal agencies Internal controls Medicare Prospective Payment System DOJ/HHS Laboratory Unbundling Project Medicare Program DOJ/HHS 72 Hour Window Project Title 31 Section 3729(a) 31 U.S.C. 3729(a) Public Law 105-277