Investigations of Fraud and Abuse

Jun 17th, 2015
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At the 1996 Interim Meeting, the House of Delegates adopted Resolution 222, calling for the AMA to "closely monitor the activities of all agencies engaged in investigating and prosecuting fraud cases."

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Investigations of Fraud and AbuseReport of the Board of Trustees of the AMABoard of Trustees Report 27 (I-97)Subject: Federal Government Investigations of Fraud and Abuse in the Delivery of Health CareServicesPresented by: Thomas R. Reardon, MD, ChairAt the 1996 Interim Meeting, the House of Delegates adopted Resolution 222, calling for theAMA to "closely monitor the activities of all agencies engaged in investigating and prosecutingfraud cases." At the 1997 Annual Meeting, the House of Delegates adopted Resolution 8l0 whichincluded a resolve asking the AMA to "develop a straightforward statement of physicians' rightsin fraud and abuse investigations." These two resolutions were adopted in the aftermath ofsignificant publicity on the scope of fraud in the health care community and resulting federallegislation to enhance the ability of the federal government to fight fraud in the health caresector. Both resolutions requested a report back to the House of Delegates at the 1997 InterimMeeting.BackgroundProvisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), PublicLaw l04-191, enhance the ability of the federal government to recoup health care spending thatmay be categorized as inappropriate payments, including fraud. Among other provisions, thislaw: created the Medicare Integrity Program that allows the Department of Health and HumanServices (HHS) to enter into contracts with private entities to review and audit activities wher

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