Last week, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced a new False Claims Act Working Group to spur collaboration between the agencies in their use of the federal False Claims Act to prosecute healthcare fraud. The announcement of the working group also identified the administration’s priorities for healthcare fraud enforcement.
The Working Group will be jointly led by HHS General Counsel, HHS-OIG Chief Counsel, and the Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch. Members of the group will also include leadership from those offices as well as from the Centers for Medicare & Medicaid Services Center for Program Integrity, and representatives from U.S. Attorney’s Offices.
The partnership between DOJ and HHS will increase coordination between the agencies for the purpose of bringing additional resources to bear on enforcement in the six areas announced as enforcement priorities for the Working Group. Those six areas are:
- 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.
In addition to using cross-agency collaboration to more readily identify leads and accelerate pre-existing investigations, the Working Group plans to employ data mining and analysis of HHS and HHS-OIG report findings to better utilize HHS resources in pursuit of investigations.
The announcement specifically encourages whistleblowers to report potential violations of the False Claims that fall into the priority areas the Working Group identified. The “qui tam” or whistleblower provision of the False Claims Act allows a private citizen to file a case reporting fraud, including healthcare fraud, and potentially claim a reward from the government if the case is successful.
Since the passage of the modern False Claims Act in 1986, the law has been used to recover more than $78 billion in settlements and judgments. False Claims Act cases involving healthcare fraud—including the types of conduct the Working Group identified as priorities—consistently remain one of the top sources of recovery for the government. For example, in fiscal year 2024, the Department of Justice reported that over $1.67 billion of the approximately $2.9 billion in total recoveries from the False Claims Act was attributed to healthcare cases.
Phillips & Cohen has brought successful cases in areas that are current priorities for the Working Group, including cases addressing Medicare Advantage fraud, kickbacks related to goods paid for by the federal government, abuse of Electronic Medical Records systems, barriers to patient access to care, and defective medical devices.
Phillips & Cohen has extensive expertise in all areas of healthcare fraud. If you know of potential healthcare fraud and would like to speak with an experienced whistleblower attorney, contact Phillips & Cohen for a confidential review of your case.
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