On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) detailed the DOJ-HHS False Claims Act Working Group, a collaboration between the two agencies to further False Claims Act enforcement actions targeting healthcare fraud.
The release outlines the following priority enforcement areas:
- “Medicare Advantage
- Drug, device or biologics pricing, including arrangements for discounts, rebates, service fees, and formulary placement and price reporting
- Barriers to patient access to care, including violations of network adequacy requirements
- Kickbacks related to drugs, medical devices, durable medical equipment, and other products paid for by federal healthcare programs
- Materially defective medical devices that impact patient safety
- Manipulation of Electronic Health Records systems to drive inappropriate utilization of Medicare covered products and services”
According to the release, “the Working Group shall maximize cross-agency collaboration to expedite ongoing investigations in these priority areas.”
The release describes the False Claims Act as “one of the government’s most effective and successful tools to combat healthcare fraud.” A key aspect of the FCA’s success are its qui tam provisions, which enable whistleblowers to file lawsuits on behalf of the U.S. against companies and individuals committing fraud against the government, including healthcare fraud.
Since the FCA was modernized in 1987, the U.S. has recovered over $54 billion in FCA settlements and judgements relating to healthcare fraud. Of this total, nearly $42 billion stemmed from cases initiated by qui tam whistleblowers.
“The DOJ-HHS False Claims Act Working Group encourages whistleblowers to identify and report violations of the federal False Claims Act involving priority enforcement areas,” the government’s release states.
Individuals considering blowing the whistle on healthcare fraud should first consult an experienced FCA whistleblower attorney to help ensure they file an effective qui tam suit and that they are protected from retaliation.
Geoff Schweller also contributed to this article.