Health Information Management

News: DOJ recovers record $3 billion from fraud claims

CDI Strategies, December 9, 2010

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The Department of Justice (DOJ) recovered $2.5 billion in healthcare fraud recoveries for fiscal year (FY) 2010—the largest in history—and $3 billion in total civil fraud claims, according to a DOJ press release. Of that, $2.3 billion was recovered via False Claims Act’s qui tam provisions which encourage employees to inform the government of potential False Claims Act violations.

Common False Claim Act areas of risk, many which affect CDI, include:
  • Inaccurate coding
  • Upcoding
  • Billing for medically unnecessary services
  • Billing for services not provided
  • Insufficient documentation
Editor’s Note: This article first appeared in Compliance Monitor.



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