Enforcement: Healthcare Fraud Recoveries Exceed $2 Billion in 2019

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews 2019 federal healthcare fraud enforcement results and explains why the Department of Justice’s recoveries matter to healthcare organizations, compliance teams, and coding/billing professionals. It highlights broad categories of alleged misconduct involving manufacturers, laboratories, health IT vendors, rehabilitation facilities, and other providers, along with the government agencies and statutes involved. The piece is useful for readers tracking enforcement trends, compliance risk areas, and the types of cases driving healthcare fraud recoveries.

Why This Topic Matters

Healthcare fraud enforcement can affect compliance programs, billing practices, provider relationships, and documentation workflows across many settings. Understanding the major enforcement themes helps organizations monitor risk and prepare for continued government scrutiny.

Article Sections

  1. Background

    Summarizes the federal recovery totals for fiscal year 2019 and places them in the context of broader civil healthcare fraud enforcement activity. It also introduces the general enforcement climate heading into 2020.

  2. See a Breakdown of the 2 Biggest Settlements

    Reviews two of the largest opioid-related enforcement matters discussed in the article. The section focuses on the types of allegations and the scope of the government resolutions.

  3. Feds Spotlight Healthcare Providers’ Fraud Woes

    Examines several provider and vendor cases involving alleged improper financial relationships, health IT issues, and billing-related misconduct. The section describes how these matters contributed to the year’s overall recoveries.

What You Will Learn

  • How federal healthcare fraud recoveries were characterized for fiscal year 2019
  • What broad enforcement areas drew government attention during the year
  • Which general types of healthcare entities were involved in major cases
  • How compliance concerns can arise across manufacturers, providers, labs, and health IT vendors
  • Why these enforcement trends matter for healthcare organizations in 2020

Who Should Read This

  • Healthcare compliance professionals
  • Medical coders and billing staff
  • Revenue cycle teams
  • Healthcare attorneys
  • Healthcare administrators
  • Audit and fraud prevention teams

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