	Background

To emphasize fair and responsible use of the False Claims Act, DOJ issued “Guidance on the Use of the False Claims Act in Civil Health Care Matters” on June 3, 1998. These steps have helped to encourage compliance. DOJ Evaluation Process Now Provides Meaningful Assessment of Compliance With the Guidance

We found that DOJ’s periodic evaluations of the U.S. Attorneys’ Offices now incorporate a more substantive examination of compliance with the guidance. U.S. Attorneys’ Offices Certify Compliance

DOJ’s annual requirement that all U.S. Attorneys’ Offices involved in national civil health care fraud initiatives certify their compliance with the guidance appears to have promoted compliance at the offices we visited. PPS Transfer and Pneumonia Upcoding Initiatives Are Being Conducted in Accordance With the Guidance

Based on our analysis of working group materials and review of case files at four offices, we believe that DOJ is following its guidance as it pursues the PPS Transfer and Pneumonia initiatives. In addition, the working groups have prepared model contact letters and other documents to ensure that hospitals are contacted in a manner consistent with the guidance. These associations also did not identify instances of U.S. Attorneys’ Offices failing to comply with the guidance. It has strengthened its oversight of U.S. Attorneys’ Offices.
Why GAO Did This Study

In June 1998, The Department of Justice (DOJ) issued guidance on the fair and responsible use of the False Claims Act in civil health care matters. This report evaluates DOJ's efforts to ensure compliance with the guidance and focuses on the application of the guidance in two recent DOJ initiatives-the Prospective Payment System (PPS) Transfer and Pneumonia Upcoding Project.

What GAO Found

GAO found that DOJ has taken steps to further strengthen its oversight of compliance with its False Claims Act guidance. These steps include (1) reviewing each U.S. Attorneys Office's compliance with the guidance as part of the periodic evaluation of all U.S. Attorneys' Offices, (2) requiring all U.S. Attorneys' Offices involved in civil health care fraud control to certify their compliance with the guidance, (3) forming working groups to coordinate national initiatives, and (4) maintaining ongoing contacts with participating U.S. Attorneys' Offices to help ensure that they are complying with the guidance. GAO also found that DOJ is implementing the PPS Transfer and Pneumonia Upcoding projects in a manner consistent with the guidance.