Memo: Health Care Systemic Reports

 


Office of the Attorney General
Washington, D.C. 20530

                  June 2, 1997

MEMORANDUM FOR THE HEADS OF DEPARTMENT COMPONENTS

FROM:                  THE ATTORNEY GENERAL

SUBJECT:             Health Care Systemic Reports
 

    In 1993, I made health care fraud a high priority for the Department of Justice in recognition that health care fraud not only imposes significant financial costs on taxpayers, consumers and insurers, but also endangers the quality of care provided. Since that time, we have strengthened and expanded significantly the investigation and prosecution of health care fraud with tremendous success. You should be congratulated for these efforts.

    An effective health care fraud control program, however, requires not only aggressive detection, investigation and prosecution, but also vigorous prevention. We need to stop the fraud before it occurs and stop payment before it is made to fraudulent providers. We already have pursued considerable steps to this end at the national and local levels, including promotion of compliance programs and outreach to beneficiaries and providers to increase public awareness of fraudulent schemes and our efforts to combat them.

    But we can do even more to promote health care fraud prevention. In the course of your enforcement efforts, you may discover problems in health programs or plans that should be addressed through administrative, regulatory, legislative or policy change. I now have approved a protocol to enable Department of Justice investigators and prosecutors to report such systemic weaknesses so that the appropriate agency officials can take corrective action. (The systemic weakness reporting protocol is attached).

    I urge all Department of Justice prosecutors and investigators to prepare a systemic report whenever, during the course of investigating or prosecuting health care fraud, it appears that a policy, procedure or systems process in a health care benefit program has failed to prevent, detect, or minimize losses due to fraud, waste, abuse or mismanagement. Systemic weakness reports from all components will be submitted to the Civil Division, which will identify issues of national significance and refer the reports to the appropriate departments or agencies so that they can take corrective action.

    I look forward to hearing the results of your efforts to combat health care fraud through vigorous investigation, prosecution and prevention.

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