DOJ’s Health Care Fraud Unit Sees Growth and Notable Results in FY 2018

January 10, 2019

The U.S. Department of Justice (DOJ) Criminal Division recently released its Fraud Section Year in Review for 2018.  The Fraud Section runs three litigating units, including the Health Care Fraud (HCF) Unit.  The HCF Unit is the largest unit comprised of 60 prosecutors who work to identify and prosecute health care fraud-related cases.  A full copy of the annual report is available here.

This annual report touts the effectiveness of the HCF Unit showing its “Impact on Investment” calculated at approximately $100 to $1 for FY 2018.  Further, the HCF Unit saw growth in 2018 with an increase of 10 prosecutors.

The focus for 2018 included prosecuting individuals, with a specific emphasis on individual prosecutions related to opioids.  According to the report, 309 individuals were charged in 2018, of which 67 individuals were charges with opioid-related crimes.  These numbers represent a 40% increase in the number of individuals charged overall and a 56% increase in opioid defendants as compared to 2017.

The HCF Unit also brought one notable corporate criminal enforcement action in 2018 involving Health Management Associates, LLC.  This global resolution resulted in over $260 million paid to resolve criminal charges and civil claims related to a scheme to defraud health care programs.

In October 2018, the HCF Unit launched the Appalachian Regional Prescription Opioid (ARPO) Strike Force.  The ARPO Strike Force was established to better target criminal conduct associated with the improper prescription and distribution of prescription opioids by physicians, pharmacists, and other medical professionals.

The HCF Unit is expected to continue bringing large, complex fraud and opioid criminal prosecutions in 2019.  If you are facing an audit, subpoena, or other inquiry from a health care benefit program or government enforcement agency and have questions about how to respond, please contact a member of Hancock Daniel’s Healthcare Investigations and Enforcement Actions team.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson PC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson PC be liable for any direct, indirect, or consequential damages resulting from the use of this material.

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