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Health Care Fraud to Remain a DOJ Priority

Exclusion News (May 22, 2017):
By Paul Weidenfeld

Health Care Fraud will continue to be a high priority of the Department of Justice Kenneth Blanco, the Acting Head of the Criminal Division.  Describing health care fraud as “egregious,” “despicable” and driven by “greed” – Mr. Blanco, told the iABA Health Care Fraud Institute last week. went on to say that the department would be “vigorous” in its pursuit of those who violate the law in this area.”

Department of Justice announcements of its commitment to health care fraud enforcement are common and would hardly have been noticed in prior administrations. But by going out of his way to “be clear” that health care fraud is “something that Attorney General Sessions feels very strongly about” and remains a “priority” for DOJ, Mr. Blanco appears to be sending the message that health care fraud had not been left behind in a Justice Department that has been pursuing several new initiatives and has several new areas of focus. 

A Concern that Health Care Fraud Deprives Care to the those in Need

While patient safety and financial costs have been the longstanding focus of health care fraud enforcement, Mr. Blanco told the conference attendees that money stolen is “important,” but that his focus was on the impact that health care fraud has by denying services to those in need. In his view, health care fraud “deprives many people of access to medical care, even the most basic forms of care, because fraud increases the costs for all of us and shuts out those who are the most needy or those in society who are just making it.”

The assertion that there is a direct linkage between health care fraud and the deprivation of services to certain specific segments of the population appears to stake out new ground in the fight against health care fraud. It will be interesting to see if this slight shift in concerns results in any change in health care fraud enforcement policies or investigation goals.

Data Mining and Information Sharing Driving Enforcement

Mr. Blanco also discussed recent investigations and stressed that the “cooperative partnerships” between the criminal division strike force, the investigative agencies and the U.S. Attorney’s Offices were critical to the recent enforcement successes. To this point, he noted that last years “national health care fraud takedown” involved 36 separate U.S. Attorney’s Offices and many State Medicaid Fraud Control Units while resulting in charges against 301 individuals and alleged false billings in the amount of $900 million.

The wide array of investigative and prosecutorial tools at the divisions disposal and the advanced data mining techniques being employed were also credited. As Mr. Blanco stated, “We now have an in-house data analytics team headed by some of the best and brightest. Analyzing billing data from CMS has become a key part of our investigations because it permits us to focus on the most aggravated cases and to identify quickly emerging schemes and new types of Medicare fraud…We have the opportunity to halt schemes as they develop. This cutting-edge method has truly revolutionized how we investigate and prosecute health care fraud.”

Final Thoughts 

The Justice Department may have new leadership, new interests and new initiatives, but last week appears to be intended to send a “clear” message that it’s interest and focus on health care fraud will remain strong under Mr. Sessions.  It will be interesting, however, to keep an eye on whether there is a “shift” in focus to a consideration of the impact of fraud upon the long term availability of services; and if so, what form that shift might take in terms of future cases or initiatives.