Publication | July 2024
The Department of Justice (DOJ) recently announced another of its annual healthcare fraud “takedowns.” Consistent with previous takedowns, this year’s announcement touts criminal charges against 193 individuals (76 of whom are providers) and a massive amount of fraudulent billings (approximately US$2.75 billion). This annual “shock-and-awe” enforcement spectacle reinforces the government’s focus on combatting healthcare fraud … and Texas remains a major focal point for these efforts.
DOJ’s annual takedown press releases provide insight into the Department’s current healthcare fraud enforcement priorities. Not surprisingly, diversion of opioids and other controlled substances remains a major focus. Additionally, services that were medically unnecessary, unduly expensive, tainted by kickbacks or simply not provided were common aspects of the fraudulent schemes. Labs and telemedicine also continue to draw law enforcement scrutiny.
The DOJ’s press release reinforces law enforcement’s continued commitment to inter-agency collaboration and includes accolades for the many different federal and state law enforcement agencies that worked together to develop these cases. Importantly, in addition to the criminal charges mentioned, the press release also references 127 administrative actions taken by the Centers for Medicare & Medicaid Services (CMS) in the last six months against providers for their alleged involvement in health care fraud schemes. And, do not forget that the DOJ persistently remarks that the civil False Claims Act (and its qui tam whistleblower provisions) remain one of its main fraud enforcement tools as well. In short, the blurred lines between federal, state, civil, administrative and criminal enforcement teams are increasingly hazy … and dangerous for providers.
Norton Rose Fulbright’s experienced Healthcare Investigations team represents businesses and executives in government investigations. If you find yourself involved in a government investigation, or if you receive a government subpoena or civil investigative demand (CID), our team will defend your interests aggressively and effectively. Please let us know how what we can do to help.
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