DOJ’s use of the False Claims Act currently includes three national  initiatives involving hospitals. Similarly, DOJ’s requirement that all U.S. Attorneys’ Offices involved in  civil health care fraud matters annually certify their compliance with the  guidance, a process also instituted 2 years ago in response to our  recommendations, appears to have continued to promote compliance. The working groups have continued to be involved in the development and  implementation of the national initiatives. It also  enables offices to devote individualized attention to each hospital’s unique  circumstances, such as its efforts to comply with billing rules and its  financial condition, as the guidance requires. Hospital Associations Express Few Concerns Regarding DOJ’s Compliance with the Guidance

Representatives from the AHA and the eight state hospital associations we  spoke to were generally satisfied that U.S. Attorneys’ Offices were  adhering to DOJ’s False Claims Act guidance in the national initiatives. DOJ has instituted sufficient  monitoring of U.S. Attorneys’ Offices participating in the national  initiatives and other civil health care fraud matters to help ensure that  offices use the act in a fair and even-handed manner.
What GAO Found

The Department of Justice (DOJ) recovered more than $1.2 billion in health care fraud cases in fiscal year 2001. The False Claims Act bolstered DOJ's recoveries and enabled the government to seek damages and penalties against providers who knowingly submitted fraudulent bills to Medicare, Medicaid, or other government programs. In the late 1990s, industry representatives voiced concerns that DOJ had over zealously pursued hospitals, conducted unwarranted investigations, and demanded large penalties for unintentional errors. In response, DOJ issued guidance that emphasized the importance of using the act in a fair and even-handed manner and introduced new procedures for national initiatives. DOJ requires all U.S. Attorneys' Offices that pursue civil health care fraud to annually certify their compliance with the guidance. DOJ appears to be conducting its three national initiatives consistent with the guidance. U.S. Attorneys' Offices that GAO visited had coordinated their activities with the national initiative working groups and, as the guidance requires, took each hospital's unique circumstances into consideration in resolving these matters. Representatives from the American Hospital Association and the state hospital associations GAO spoke to were generally satisfied that U.S. Attorneys' Offices were adhering to DOJ's False Claims Act guidance.