Healthcare Fraud Remains a Major DOJ Priority

Back in February, the Department of Justice’s Criminal Division Fraud Section released its annual review. Of the Fraud Section’s three litigation divisions, Health Care Fraud, Market Integrity and Major Frauds and Foreign Corrupt Practices Act, Health Care Fraud is the largest with nearly twice as many trial attorneys and the most active unit.

In addition to the usual statistics about the number of attorneys, defendants charged and number of trials, the report also announced a change in how their trial attorneys are assigned in the field. Previously, trial attorneys were assigned to strike force cities in 24 judicial districts. Under the new deployment, the cities are grouped into regions allowing a broader approach and sharing of resources in wider areas.

The report noted that enforcement actions were prioritized in areas involving pharmaceuticals, telemedicine, laboratory testing and durable medical equipment. There is also an emphasis on vulnerable populations, such as the elderly or addicted patients.

DOF continues to utilize its analytics unit to identify suspicious healthcare billing patterns and geographic hot spots for fraudulent activities. The analytics unit, formed in 2018, provides proactive referrals based on the data analysis.