An official from the Department of Justice (“DOJ”) recently announced the DOJ’s plans to “substantially” add to its current roster of 75 prosecutors specializing in healthcare fraud. On November 7, John “Fritz” Scanlon, assistant chief of the DOJ’s criminal division, fraud section, who spoke at a Healthcare Compliance Association conference in Washington, D.C., stated that the 75 prosecutors are distributed among seven strike forces across the U.S. The DOJ uses nine interagency strike force teams to root out alleged fraudulent activities, particularly focusing on Federal healthcare program fraud and abuse. These teams are spread throughout the country, focusing on regions in the U.S. like Florida and Texas, but several strike force teams also specialize in certain subject matters.
The strike force teams use advanced data analytics, combined with traditional investigative methods, to target patterns of billing abuse in cities with high volumes of billing fraud. Additionally, the teams focus on healthcare schemes and trends that may be ripe for abuse.
Recent Enforcement Actions & Areas to Watch
Recently, the DOJ has been watching telemedicine closely, bringing several enforcement actions against individuals alleged to have perpetrated telemarketing schemes with clinical laboratory testing or durable medical equipment companies. In 2022, the DOJ charged 36 defendants for more than $1.2 billion in alleged fraud, and recovered $8 million. These cases involve allegations of using telemedicine to offer low cost or free products or testing to beneficiaries, ordering these products or tests, and then selling those items to a medical equipment company or laboratory who then provides a kickback to the telemedicine company.
In June 2023, the DOJ announced a large-scale, coordinated healthcare enforcement effort charging 78 individuals in $2.5 billion worth of alleged fraud and abuse. This particular large-scale enforcement action spanned several “hot” areas for fraud and abuse enforcement, from telemedicine fraud to pharmaceutical fraud to opioid distribution.