Key Takeaways
- The DOJ and HHS announce a strengthened partnership through a new False Claims Act Working Group, aimed at ramping up health care fraud investigations.
- The new False Claims Act Work Group will prioritize areas including Medicare Advantage fraud, improper pricing arrangements with pharmaceutical drugs, kickback schemes, barriers to patient care access, and unnecessary utilization of Medicare services and products.
In a joint announcement, the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) unveiled the formation of the new DOJ-HHS False Claims Act Working Group (Working Group) – a strategic enforcement partnership aimed at ramping up investigations and prosecutions of healthcare fraud under the False Claims Act (FCA). This announcement comes days after the DOJ’s announcement of their largest-ever National Health Care Fraud Takedown.
The Working Group brings together senior officials from DOJ’s Civil Division, U.S. attorneys’ offices, the HHS Office of General Counsel, the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services Center for Program Integrity.
The initiative underscores the DOJ’s continued focus on prioritizing healthcare fraud and abuse enforcement. The Working Group will focus on priority enforcement areas, including:
- Medicare Advantage fraud
- Improper drug, device and biologic pricing arrangements, including rebates, service fees and false price reporting
- Barriers to patient access to care, including violations of network adequacy requirements
- Kickback schemes involving drugs, devices, durable medical equipment and other products paid for by federal healthcare programs
- Materially defective medical devices impacting patient safety
- Manipulation of electronic health records systems to promote the unnecessary utilization of Medicare services and products
As part of its mission, the Working Group will expedite investigations, increase data-sharing between agencies and use advanced data analytics and enhanced data mining to identify fraudulent schemes. It will also coordinate decisions on payment suspensions under HHS regulations and DOJ motions to dismiss meritless qui tam suits under 31 U.S.C. § 3730(c)(2)(A). Importantly, the Working Group encourages whistleblowers and companies to report suspected FCA violations. This renewed interagency coordination reflects a broader trend toward proactive, data-driven FCA enforcement in the healthcare sector and signals increased scrutiny of providers, manufacturers and payors operating in federally funded healthcare programs.
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