DCIS pursues aggressive qui tam program
The Department of Defense Criminal Investigative Service (DCIS), which helps oversee more than $5 billion in spending for 8.2 million active duty and retired military personnel and their dependents through TRICARE, is shaping up as the new health care enforcer on the block.
DCIS already has an aggressive qui tam program, and last year the agency opened 55 cases based on referrals, according to Joseph McMillan, special agent in charge of the DCIS Mid-Atlantic field office based in Arlington, VA. He says DCIS currently is investigating 529 health care fraud matters ranging from upcoding and overbilling to quality of care.
McMillen says DCIS will continue to emphasize the investigation of health care fraud as it involves TRICARE and federal health insurance programs impacting the Department of Defense. DCIS reported approximately $626 million in recoveries last year.
According to McMillen, DCIS also is forging relationships at TRICARE and with other law enforcement agencies to establish data-mining capability for health care investigations and has participated in more than 70 nationwide task forces. DCIS is participating with the Department of Justice, the Department of Health and Human Services’ Inspector General, and other agencies to develop ways to share open and closed health care information.
This summary information would be entered in a secure centralized database system, reports McMillen. Agencies then could conduct queries to determine if the same target was being investigated by multiple agencies. He says DCIS also is monitoring medical privacy guidelines to assess their impact on federal law enforcement and investigations.
The role of DCIS also is likely to grow along with the size of TRICARE, which last month started offering 1.4 million Medicare-eligible uniformed services beneficiaries age 65 and older new pharmacy benefits using retail and mail-order outlets. McMillen says that DCIS already is working to identify potential areas of fraud in this new system.
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