Much of the discussion surrounding President Trump’s 2018 budget blueprint has focused on cuts, but one proposed budget increase shows the new administration is likely to continue focusing on healthcare fraud enforcement. Among cuts of approximately 18% to the budget of the Department of Health and Human Services (HHS), the president’s budget proposes $70 million in additional funding for the Health Care Fraud and Abuse Control program (HCFAC), a more than 10% increase.
HCFAC is jointly directed by the Secretary of HHS and the Attorney General and is supervised by the HHS Office of Inspector General. The program coordinates federal, state, and local healthcare fraud enforcement efforts. According to the president’s budget, the HCFAC program returns more than $5 in fraud recovery for every dollar spent.
The increase in HCFAC funds suggests that the new administration will not deemphasize healthcare fraud investigations and prosecutions, despite new HHS Secretary, and physician, Tom Price’s statement at his confirmation hearing that healthcare fraud enforcement should focus on truly bad actors and focus less on scrutinizing the medical necessity of treatments. Compliance should thus remain a priority for all healthcare providers and fraud investigations are likely to continue to be a top concern. Secretary Price also spoke in favor of using data analysis to scrutinize payments for red flags before they are made, as opposed to the government’s traditional practice of investigating suspicious cases long after payment has been made. Such analysis, already used by the government, may raise the immediacy and importance of compliance for providers. Data analysis may also mean that more healthcare fraud is first identified by the government, decreasing the importance of whistleblowers bringing qui tam suits.
Although there is no prospect of the president’s budget blueprint becoming law in the immediate future and any enacted budget is likely to face significant changes, the funding increase for HCFAC shows that, despite the new administration, healthcare fraud is likely to continue to be a major priority of government regulators and prosecutors.