The Consequences of not having a compliance program
Healthcare Fraud
US DEPARTMENT OF JUSTICE,
OCTOBER 1, 2020
HEALTHCARE FRAUD UNIT
https://www.justice.gov/criminal-fraud/health-care-fraud-unit
The Criminal Division, Fraud Section’s Health Care Fraud (HCF) Unit is comprised of more than 70 prosecutors whose core mission is to prosecute health care fraud-related cases involving: (1) patient harm; and/or (2) large financial loss to the public fisc. The HCF Unit has a recognized and successful Strike Force Model for effectively and efficiently prosecuting cases across the United States. Accomplishing specific and general deterrence, and protecting vulnerable patient populations, lie at the heart of its work.
The Strike Forces are modeled on a cross-agency collaborative approach, bringing together the investigative and analytical resources of the FBI, the Department of Health and Human Services Office of Inspector General (HHS-OIG), the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity (CPI), and other agencies (e.g., DEA, IRS-CI, USSS, FDIC-OIG, DOD-OIG, USPIS, DOL-OIG, DCIS), and the HCF Unit’s internal Data Analytics Team, along with the prosecutorial resources of U.S. Attorney’s Offices and state and local law enforcement partners.
Because the HCF Unit’s attorneys work full-time on HCF cases, we have become experts in prosecuting HCF-related offenses and are well-equipped to pursue significant cases involving medical professionals; corporations and executives; wide-ranging, complicated fraud schemes; and the illegal distribution and diversion of opioids and other prescription medications. The HCF Unit charges a broad range of federal statutes based upon the facts and issues involved in each case, including, but not limited to: health care fraud; wire fraud; mail fraud; bank fraud; conspiracy; money laundering offenses; false statements offenses; violations of the Anti-Kickback Statute and Title 42 offenses; tax offenses; and Title 21 offenses.
The HCF Unit currently works in the following Strike Force locations, in partnership with the U.S. Attorney’s Offices in these regions:
- Florida (Miami, Tampa, Orlando)
- Los Angeles, CA
- Texas (Houston, Dallas, McAllen/Rio Grande)
- The Gulf Coast (New Orleans, Baton Rouge, and Southern Mississippi)
- Detroit, MI
- Brooklyn, NY
- Chicago, IL
- Newark, NJ and Philadelphia, PA
- Washington, DC (National Rapid Response Strike Force)
- Kentucky, Ohio, Virginia, and West Virginia (ARPO North)
- Tennessee and Northern Alabama (ARPO South)
The HCF Unit’s cases are increasingly complex, both in the individual Strike Force locations and the National Rapid Response Strike Force. Specifically, the newly created National Rapid Response Strike Force’s mission is to investigate and prosecute fraud cases involving major health care providers that operate in multiple jurisdictions, including major regional health care providers operating in the Strike Force cities, with a focus on investigations and prosecutions of individuals and corporations. The National Rapid Response Strike Force will coordinate with the Civil Division’s Fraud Section and Consumer Protection Branch, U.S. Attorney’s Offices across the country, state Medicaid Fraud Control Units, the FBI, HHS-OIG, and other agency partners in order to identify, investigate, and prosecute significant multi-jurisdictional and corporate health care fraud cases. Examples of the types of matters under this Strike Force’s purview include a large-scale rural hospitals billing fraud matter indicted in the Middle District of Florida; the global resolution with Tenet Healthcare Corporation and related individual prosecutions; and prosecutions of those seeking to criminally exploit the COVID-19 pandemic through health care fraud and related financial fraud schemes.