Rooting out fraud.

N ov. 22, 2009, marked a significant milestone for Tamar Abell. It was the end of a 10-year ordeal that cost her family’s skilled nursing facility business more than $2 million in settlement costs and legal fees, not to mention numerous sleepless nights and hundreds of hours of paperwork. It began in the spring of 2000: After three decades of successfully owning and operating nursing facilities, one of Abell’s properties was hit with an investigation prompted by the allegations of a “whistleblower” who recently had been fired from the company. The U.S. Health and Human Services (HHS) Office of Inspector General (OIG) spent four years investigating the facility before a lawsuit was filed. Each of the business owners—Abell, her husband, brother, and father—were sued by the federal government under the civil False Claims Act (FCA) and placed under a quality-of-care corporate integrity agreement (CIA) that required federal officials to monitor each of of the company’s facilities for a period of five years. It never occurred to Abell that she would be sued. “I considered myself to be a ‘typical’ mom and pop provider,” she says. “I thought everything was going well. I thought this only happened to the big companies.” Making matters worse, the facility under investigation had been managed by Abell’s company for only 16 months when at least a dozen federal officials marched into the lobby with subpoenas in hand. What’s more, the facility itself was unlike any other she had managed before. Having “grown up” with skilled nursing facilities, this particular building, which served inner-city young adults with mental illnesses, was a very different ballgame. “We knew going in that this was not going to be easy, but we did make improvements, and we had just had a good survey,” says Abell. But by the time they pulled out of the facility, just 18 months in, it was too late. Abell’s story does have a happy ending, but it serves as a cautionary tale of how earnest the federal government has become in its efforts to crack down on fraud, waste, and abuse in the Medicare and Medicaid programs. OIG and the U.S. Department of Justice (DOJ), as well as the Office of the U.S. Attorney General (AG), the Centers for Medicare & Medicaid Services (CMS), and most of the states have intensified their efforts in unprecedented ways to recoup overpayments, prevent billing errors and upcoding, and snag more onerous perpetrators in the act of billing for services never rendered or for deceased beneficiaries. Rooting Out Fraud Under the government’s