What Health Care Organizations Need to Know About Electronic Discovery—Five Considerations That Should Not Be Overlooked During Health Care Fraud Investigations

Federal healthcare fraud investigations and enforcement actions have steadily increased in recent years. In 2009, the Departments of Justice ("DOJ") and Health and Human Services ("HHS") formalized a joint initiative, the Health Care Fraud Prevention and Enforcement Action Team ("HEAT"), to prevent healthcare fraud and provide increased enforcement of anti-fraud laws.

Under HEAT, a Medicare Fraud Strike Force was formed by creating a multi-agency team of federal and local investigators, analysts and prosecutors who utilized data analytics as well as conducted undercover operations to identify and expose the fraud. Since 2007 strike force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program.

In Fiscal Year 2013, the government recovered a historic $4.3 billion, up from 4.2 billion in Fiscal Year 2012, and has returned a record-breaking $19.2 billion dollars to taxpayers between 2009 and 2013, up from $9.4 billion dollars over the prior five years. These amounts have trended upwards over the past decade and in all likelihood will continue to do so. As part of the government's increased enforcement efforts, it is not unusual for healthcare entities to be the recipient of a Civil Investigative Demand ("CID"), Subpoena or Search Warrant once the investigation commences.