US Department of Justice announces national healthcare fraud takedown

The Department of Justice (DOJ) announced another historic "takedown" of medical professionals and other individuals allegedly engaged in healthcare fraud. Consistent with takedowns from previous years, this year's announcement touts jaw-dropping amounts of fraudulent billings (approximately US$1.4 billion) and indictments (138 individuals charged) reinforcing the government's relentless focus on the healthcare industry. The takedown shows another coordinated effort between federal law enforcement agencies, including the DOJ's Strike Forces, HHS-OIG, FBI, DEA, IRS and CMS.

Texas remains a major focal point for the government's enforcement efforts.

The September 17 announcement demonstrates the heightened enforcement focus on four areas:

• Telemedicine
• COVID-19 pandemic relief
• Sober homes
• Opioid diversion and fraud

Importantly, the DOJ emphasized that more than 30 percent of the indictments mentioned were of medical professionals (doctors, nurses and other licensed medical professionals). Moreover, the announcement underscores the importance of the DOJ's Healthcare Fraud Strike Force operations and multi-agency cooperative efforts. Law enforcement efforts have become more and more cooperative in nature, with agents and attorneys from a wide range of agencies partnering to share and mine data, health insurance reporting and whistleblower complaints, among other information. This increasingly partnership- and data-driven enforcement model raises a host of risk points for individuals and businesses in the healthcare industry.

Notably, this announcement indicates at least five of the charged defendants are alleged to have misused Provider Relief Fund monies. The Provider Relief Fund was established as part of the CARES Act and we continue to expect the government to pursue cases involving the alleged abuse of pandemic relief programs.  

Given the complexities of the laws and the aggressiveness of these law enforcement efforts, we recommend that no healthcare provider engage with government authorities without experienced and skilled counsel.

Norton Rose Fulbright represents businesses and executives in government investigations, with an experienced team to address healthcare fraud investigations. If you or your business finds itself involved in a government investigation, or if you receive a government subpoena or civil investigative demand (CID), our team is prepared to aggressively defend your interests.

Special thanks to senior associate Chris Cooke (San Antonio), who works under the supervision of Jay Dewald, for assisting in the preparation of this content.