HHS, DOJ Form Joint Working Group to Crack Down on Fraud

WASHINGTON—On the heels of revealing a huge federal fraud takedown operation, the current administration has made another move, indicating it is taking a hard line on health care fraud.

Last week, the Department of Health & Human Services (HHS) and the Department of Justice (DOJ) announced the formation of a joint False Claims Act (FCA) Working Group. Under the auspices of the working group, HHS will refer potential FCA violations to the DOJ, prioritizing Medicare Advantage, barriers to patient access to care, kickbacks for durable medical equipment, defective devices and more. 

Health care attorneys warned that health care providers should ensure they are keeping up with compliance efforts and are ready to respond to queries.  

“This new initiative underscores a coordinated federal enforcement strategy focused on identifying and addressing fraud in federally funded health care programs, particularly Medicare Advantage and Medicaid managed care,” read a web post from the law firm Crowell and Moring LLP. The government also recently launched a “Health Care Fraud Data Fusion Center” staffed with data specialists tasked with identifying and attacking emerging fraud schemes, Crowell pointed out.

“Companies operating in the targeted sectors should anticipate increased scrutiny and enforcement actions,” attorneys Megan Conway Rahman, Abigail Hazlett and Jaycee Parker of Troutman Pepper Locke posted online. “It is advisable for businesses to review their compliance programs and ensure robust measures are in place to prevent and detect potential FCA violations. Enhanced enforcement may lead to an increase in FCA investigations and litigation.”

The working group is designed to foster cross-agency collaboration for existing and new investigations, “including by leveraging HHS resources through enhanced data mining and assessment of HHS and HHS-OIG report findings,” the government said in its announcement. It will also “discuss considerations bearing on whether HHS should implement a payment suspension.”  

The creation of the workign group “signals that the federal government, aided by whistleblowers, will continue to rely heavily on the FCA for health care fraud and abuse enforcement, with HHS continuing to refer potential violations to DOJ,” health and compliance lawyers George Breen and Daniel Fundakowski of the firm Epstein Becker Green wrote in a web post.

“Health care and life sciences companies—particularly federal contractors—should remain vigilant about both traditional FCA risks (e.g., overbilling, billing for services that are not medically necessary, etc.) and emerging theories (e.g., civil rights violations),” they wrote. Organizations should also maintain a strong compliance infrastructure, monitor DOJ policy updates and foster a culture of transparency, they advised. 

Membership in the FCA Working Group will include leadership from: 

• HHS Office of General Counsel
• Centers for Medicare & Medicaid Services Center for Program Integrity
• Office of Counsel to the HHS Office of Inspector General
• DOJ’s Civil Division representing U.S. Attorney’s Offices