The Department of Justice (“DOJ”) recently announced more detailed plans for its National Fraud Enforcement Division (or “Fraud Division”), promising to increase the headcount of the Division to nearly 500 professionals by the end of August, with more growth to follow.  Among the priority areas of enforcement are public trust and financial integrity, health care, internal revenue, global trade and commerce, and corporate misconduct. 

The full Memorandum can be found here: https://www.justice.gov/opa/media/1457756/dl?inline

Health Care Fraud enforcement is not new, but the National Fraud Enforcement Division has promised to “supercharg[e] the historically successful Health Care Fraud Strike Force model with greater resources, data analytics support, and best-in-class technology.” 

Key Takeaways:

• The Fraud Division Memorandum describes several familiar themes within Health Care enforcement: telemedicine programs, Medicare and Medicaid Fraud generally, controlled substance diversion, home health and hospice, and companies and individuals marketing unsafe products and services. 
• The Division also promises to prosecute money laundering, tax and financial crimes that relate to health care.
• Health care providers, suppliers, telemedicine companies, hospice operators, and pharmaceutical and device manufacturers, among others, should anticipate increased bandwidth to result in additional activity. Even if not the target of an investigation, it is increasingly likely that individuals and entities may find themselves in the zone of enforcement activity, as witnesses or subjects.
• More bandwidth may also result in the pursuit of additional criminal cases that may have previously been declined or resolved as civil or administrative matters.
• Enhanced sophisticated data analytics to detect anomalous billing patterns could result in individuals and entities in the healthcare space having to explain their data and defend against red flags. 

With vast government resources focused on fraud enforcement, now is the time for providers, practices, and companies in the health care arena to not only be aware of heightened scrutiny across priority enforcement areas, but to review their compliance programs and prepare for potential enforcement activity.