DOJ Expects the Medicare Program Integrity Contractors to Make Criminal Referrals to DOJ

At the Health Care Compliance Association Annual Compliance Institute in Las Vegas on April 28, 2009, officials from the DOJ and the Centers for Medicare & Medicaid Services (CMS) said based on billing aberrancies detected through data analysis, New Medicare program integrity contractors are expected to generate criminal referrals to the Department of Justice (DOJ), as well as identify vulnerabilities that will be remedied at the administrative level.

DOJ Deputy Chief Kirk Ogrosky said he was surprised that the DOJ received “zero” referrals from RACs during the demonstration projects. “As a matter of statistics, we’d think there would be something,” he said of what he expected to see from RAC reviews.