In addition to losses due to fraud, the Department of Health and Human Services’ OIG has reported that billing errors, or mistakes, made by health care providers were significant contributors to improperly paid health care insurance claims. Some Advice Provided by Consultants Could Result in Violations of Law

The two workshops we attended provided certain advice that is inconsistent with the OIG guidance and that, if followed, could result in violations of criminal and civil statutes. The consultant claimed that reporting or refunding the overpayment would raise a red flag that could result in an audit or investigation.
Why GAO Did This Study

This report investigates health care consultants who conduct seminars or workshops that offer advice to health care providers on ways to enhance revenue and avoid audits or investigations. GAO attended several seminars and workshops offered by these consultants. GAO sought to determine whether the consultants were providing advice that could result in improper or excessive claims to Medicare, Medicaid, other federally funded health plans, and private health insurance carriers.

What GAO Found

GAO found that some advice was inconsistent with guidance provided by the Department of Health and Human Services' Office of Inspector General (OIG). Such advice could result in violations of both civil and criminal statutes.