News & Commentary

DOJ Healthcare Enforcement Initiative Continues

Many physicians are still shocked to learn that there can be criminal penalties related to healthcare fraud.  The U.S. Department of Justice recently announced its annual national healthcare fraud “takedown,” an event in Washington, D.C. which discussed recent actions in healthcare cases, including criminal cases.

As in the past, fraud related to home health care continues to be a priority. In recent years OIG has stressed that this area is susceptible to fraud and abuse.  Previously OIG’s counsel stated that the agencies top fraud priorities were prescription drugs and home health care.

DOJ also plans to continue its focus on pharmacy-related fraud, especially prescription drug compounding.  In one such case the Southern Louisiana Medicare Strike Force charged a pharmacist with submitting $192 million in false and fraudulent claims in Mississippi.DOJ lawyer

The emphasis on opioids will also likely continue.  DOJ highlighted that 120 of 412 defendants were charged for their roles in prescribing and distributing opioids and other narcotic drugs.

DOJ continues to investigate crimes such as conspiracy to commit healthcare fraud, violations of the anti-kickback statute, mail fraud and wire fraud, and the unlicensed distribution of prescription drugs.  DOJ has pursued allegations including bribery, kickbacks and submission of false/fraudulent claims.  False claims can include charging for services that were allegedly not medically necessary or were not provided.

DOJ also reiterated that for every dollar spent on healthcare investigations in the last three years, more than $5 was recovered.