DOJ's Health Care Enforcement Initiative Is Still Going Strong

On Thursday, June 28, 2018, the U.S. Department of Justice in connection with the U.S. Department of Health and Human Services and other law enforcement agencies announced the results of their ninth annual health care fraud “takedown.” The “take down” is an aggregation of criminal, civil and administrative health care-related actions brought over the past few weeks by Main Justice’s ten Medicare fraud strike force units, 46 different U.S. Attorney’s Offices throughout the country, and 36 state Medicaid fraud control units.

Like other prior years, the DOJ proclaimed that this year’s takedown was the “largest ever.” However, this year’s was substantially larger than prior years, demonstrating the results of increasing coordination by state and local authorities to combat health care fraud and the continuing emphasis on data analytics to investigate cases of suspected health care fraud. While last year’s takedown resulted in more than 400 arrests, this year’s resulted in a significant jump to 601 people charged, including 76 doctors, 23 pharmacists and 19 nurses, as well as other medical professionals. While last year’s takedown resulted in accountability for $1.3 billion in health care fraud, this year DOJ proclaimed that “collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings.” As set forth below, the major highlights of this year’s takedown reveal that DOJ and its law enforcement partners are sticking to many of the same enforcement areas that were central to last year’s takedown and which are highlighted in the current HHS-OIG workplan.