DOJ Forms Health Care Fraud Strike Force

The U.S. Department of Justice’s (DOJ) National Fraud Enforcement Division has established a new task force spanning several federal agencies to join the battle against hospice fraud.

The DOJ has launched the West Coast Health Care Fraud Strike Force, which is a multi-district enforcement initiative. It unites the DOJ’s Health Care Fraud Section with the U.S. Attorney’s Offices for the District of Arizona, District of Nevada and Northern District of California. Also included are the U.S. Drug Enforcement Administration (DEA) and the FBI.

The expanded effort brings more federal enforcement resources to areas seeing some of the most challenging program integrity issues across the country. The model in part involves the examination of data analytics across technology hubs in California, Arizona and Nevada to identify fraud migration across these regions. The data tactics have dismantled a number of fraud schemes, said Assistant Attorney General Colin McDonald of the Justice Department’s Fraud Division.

“Driven by data showing a significant and accelerating increase in health care fraud across all three districts, the Strike Force builds on a foundation of recent landmark prosecutions,” McDonald said in a statement. “The Fraud Division is committed to bringing that same relentless, data-driven prosecutorial force to bear across every corner of this region, making unmistakably clear that no scheme is too sophisticated, no network too large or small and no fraudster too distant to escape federal accountability.”

Thus far, the Strike Force’s model has been a “powerful tool” in the “federal enforcement arsenal,” the DOJ indicated in the statement. The model has resulted in the prosecution of more than 6,200 defendants who have allegedly collectively billed federal health care programs and private insurers more than $45 billion.

The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) also has recently announced its participation in the West Coast Health Care Fraud Strike Force. The effort strengthens collaboration among federal law enforcement partners to address the “escalating threat” of health care fraud, according to OIG Acting Deputy Inspector General for Investigations Scott J. Lampert.

“Strike Force partnerships between HHS-OIG, DOJ, U.S. Attorney’s Offices, the FBI, and the DEA are a proven force multiplier that utilizes a coordinated and data-driven approach to identifying, investigating, and prosecuting fraud,” Lampert said in an announcement. “The expansion of the West Coast Health Care Fraud Strike Force ensures that HHS‑OIG can apply our investigative tools and coordinated enforcement capabilities to identify these threats earlier and act with strategic precision.”

The Fraud Strike Force is not the first attempt at rooting out and stopping program integrity issues in the hospice space.

The U.S. Department of Health and Human Services (HHS) last year joined forces with the U.S. Centers for Medicare & Medicaid Services (CMS) to form a new Fraud Tax Project. The collaborative effort was aimed at improving program integrity by uncovering operators who are committing both health care and tax fraud.

CMS has also recently ramped up efforts to root out fraud, waste and abuse in California. The agency has identified the state as a fraud hotspot seeing swarms of new operators in recent years, along with Arizona, Nevada and Texas, and more recently Georgia and Ohio. Each of these states are under a Provisional Period of Enhanced Oversight (PPEO).

“Recent enforcement actions across Arizona, Nevada and California have revealed emerging threats targeting billions of taxpayer dollars from federal health care programs,” Lampert said. “Many of these schemes are driven by sham operations designed to appear legitimate while exploiting patients and inflating claims through increasingly sophisticated methods.

To date, only California has been the only state to take action, establishing a statewide moratorium on new hospice enrollment. More than 280 licenses have been revoked among new hospices entering the state in the past two years. Despite the progress, heightened fraudulent activity has occurred in Los Angeles County. CMS is conducting on-site investigations alongside local law enforcement, which has uncovered hundreds of fraudulent operators, some licensed at the same location. Meanwhile, the U.S. House of Representatives Committee on Oversight and Government Reform also launched an investigation into “rampant” hospice fraud in California.

Additionally, HHS joined the Departments of Justice, Homeland Security and Labor among others, in a federally-established anti-fraud task force in March, led by Vice President J.D. Vance. About 10 federal agencies are participating in the task force.

More investigative resources are needed to better understand patterns of fraud, according to Hilary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home.

“CMS doesn’t need to put a whole bunch of regulations in place to address this,” Loeffler told Hospice News at the ELEVATE conference. “They just need to better target their efforts to those committing fraud. Importantly, they just need to put boots on the ground. Get people on the ground and shut down these fraudulent hospices, period. You don’t need a new regulation to do that. You just need people and resources devoted to that effort.”