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Whistleblower Cases Expected to Increase with Additional Focus on Healthcare Fraud and Abuse

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October 15, 2014

The US Department of Justice’s criminal division continues to increase its attention on false claims in the healthcare industry. Healthcare fraud is an ongoing serious problem and more criminal cases involving fraud are expected as the DOJ ramps up its review of whistleblower cases. The division is increasing its pursuit of all false claims lawsuits, but there will continue to be special attention paid to healthcare fraud.

What is involved in the more aggressive campaign?

The DOJ’s criminal division has invested additional resources into the review of cases. The division is currently the most highly staffed criminal prosecution team dedicated to health care fraud in the country. It features 40 attorneys, which accounts for nearly half of the total number of attorneys in the department’s fraud section. This Criminal Division immediately reviews all whistleblower actions as soon as they are submitted to the Civil Division. This streamlines the review process with the goal of creating a quicker parallel criminal investigation.

Furthermore, the department has issued an invitation to the members of the Taxpayers Against Fraud Education Fund. This is a non-profit organization funded by attorneys and their whistleblower clients. The group was encouraged to reach out to criminal authorities when filing whistleblower cases, in addition to the civil division in the department.

Strike Force against Healthcare Fraud and Abuse

In addition to the review of cases, the DOJ is expected to continue its efforts in the nine Strike Force cities. The cities include:

  • Baton Rouge
  • Brooklyn
  • Chicago
  • Dallas
  • Detroit
  • Houston
  • Los Angeles
  • Miami
  • Tampa

The Medicare Fraud Strike Force is a blend of the DOJ and the Department of Health and Human Services and includes federal, state, and local investigators. Their goal is to combat Medicare fraud through the use of Medicare data analysis techniques and increased community policing. In addition to the arrests, agents executed 16 search warrants across the country in connection with various investigations.

The Medicare Fraud Strike Force charged 111 defendants in these nine cities in 2011. Those charged included heath care companies, nurses, doctors, and executives for their participation in Medicare fraud schemes. The individuals were responsible for more than $225 million in false billing. More than 700 law enforcement agents including representatives from the FBI, the HHS-Office of Inspector General, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies played a role in the operation. At the time it was the largest ever federal healthcare fraud takedown.

Efforts Against Healthcare Fraud and Abuse are Successful

In 2012, Attorney General Eric Holder and the Department of Health and Human Services released a report showing their health care fraud prevention and enforcement efforts were responsible for the recovery of nearly $4.1 billion in taxpayer dollars in 2011. It was the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or attempted to receive payments for which they were not entitled.

All of the efforts are the result of the president’s mission to make fraud, waste, and abuse elimination a top priority. The efforts would not be possible without 2009’s Health Care Fraud Prevention & Enforcement Action Team (HEAT). The team’s goal is to prevent fraud in the Medicare and Medicaid programs, and to crack down on those abusing the system.

Past and current efforts to reduce fraud are a result of the Affordable Care Act, which provides tools and resources to help fight fraud. The law included an additional $350 million for HCFAC activities. There are also efforts underway to identify fraud by examining CMS data and reviewing actions against executives, hospitals, and healthcare companies.

If you have questions about healthcare fraud or you believe you might have information on fraud taking place, we can help. Contact us for more information.

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