HHS and DOJ Launch Joint FCA Working Group, Signaling New Era in Healthcare Fraud Enforcement

by Rrita Osmani and Faaria Zubair

New Federal Task Force Zeroes In on Healthcare Fraud

A recent announcement was made regarding a major step toward coordinated enforcement between the Department of Health and Human Services (“HHS”) and Department of Justice (“DOJ”). The U.S. Department of Health and Human Services have announced the formation of a joint False Claims Act Working Group. This collaboration has brought on a significant shift and greater emphasis on False Claim Act (“FCA”) matters, specifically Healthcare Fraud.

As a result, there is urgency for whistleblowers to come forth with credible allegations regarding healthcare fraud in order to maintain the integrity of the federal healthcare system. Miller Shah LLP has extensive experience in these matters and actively litigates FCA cases in healthcare and government contracting.

What Is the New HHS-DOJ FCA Working Group?

One of the most effective and successful tools to combat healthcare fraud is the False Claims Act. The HHS and DOJ have decided to partner together to support one another in addressing healthcare matters pertaining to fraud. The DOJ-HHS False Claims Act Working Group is the partnership created to collaborate more efficiently and effectively between the two departments. This group is comprised of leadership from the HHS Office of General Counsel, the Centers for Medicare & Medicaid Services Center for Program Integrity, the Office of Counsel to the HHS Office of Inspector General (“HHS-OIG”), and DOJ’s Civil Division.

Why the HHS-DOJ Partnership Signals a New Era in Healthcare Fraud Enforcement

The HHS and DOJ have always worked together on healthcare fraud issues, but this new partnership signifiessignifies a much deeper level of commitment to address healhealthcare fraudcare fraud. With the formation of the HHS-DOJ FCA Working Group, both agencies are clearly stepping up their efforts to find and address fraud in a more targeted and proactive way. Instead of waiting for issues to surface, they are now actively seeking out potential fraud across the healthcare system. This kind of collaboration can mean faster responses and better detection of emerging threats.

Not only that, but it ggiveves whistleblowers more confidence for more confidence in their efforts and encourages their participation. When people see that these agencies are serious about addressing fraud and working together to do it, they are more likely to speak up knowing their concerns will be taken seriously and that protections will be in place to support them.

Likely Targets: What Healthcare Fraud Schemes Will Face Greater Scrutiny

The Working Group is prioritizing enforcement in the following key areas through its coordinated efforts:

• 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

FCA Whistleblower Protections and What to Know Before Reporting Healthcare Fraud

The launch of this group is an important step toward giving whistleblowers more protection and support. People are often discouraged from reporting fraud because of the fear of retaliation or other consequences. But with this increased government involvement and the agencies actively leading the charge against misconduct, there is clearly a stronger push for holding wrongdoers accountable. This kind of public support will encourage more individuals to come forward with their concerns.

This initiative is also designed to move whistleblower cases through the system more efficiently. This helps to reduce delays and signals that these reports are taken seriously by the agencies. By drawing attention to how important whistleblowing is to healthcare fraud enforcement, this effort will not only strengthen existing protections but also create momentum for more protective measures moving forward.

Things to keep in mind before reporting Healthcare Fraud:

1. You are not required to have all the answers or prove the fraud. You should come forward if you are suspicious and have information to back up your claim.
2. You should ask yourself if this fraud relates to federal funding or government programs, as it would likely be an FCA matter.
3. Whistleblowers are protected. If you report fraud, you have legal protection against retaliation.
4. If your claim leads to a successful recovery, you are eligible to receive 15 to 30% of the amount recovered.

How to Report Healthcare Fraud

1. Keep a detailed record of all evidence that supports your claim.
2. Seek legal counsel with a whistleblower attorney to help guide you through the process.
3. File a False Claims Act complaint with HHS-OIG Hotline.