DOJ National Fraud Division Sets Enforcement Priorities
The DOJ's recently formed National Fraud Enforcement Division will use advanced data analytics to pursue healthcare fraud, according to a new memorandum from its leadership.
A memorandum from Assistant Attorney General Colin M. McDonald details the enforcement priorities for the Department of Justice’s new National Fraud Enforcement Division, established earlier this year. The memo designates healthcare fraud as a central pillar of the division's mandate and signals a significant investment in prosecutorial resources and technology. Sophisticated clients and their counsel should take note of the division’s plan to deploy advanced data analytics to proactively identify exploitative schemes, a strategy building on the successful Healthcare Fraud Strike Force model. Specific areas of heightened scrutiny will include telemedicine, Medicare and Medicaid billing, the diversion of controlled substances, and home health and hospice programs. The division, which is rapidly expanding its roster of attorneys, is poised to increase enforcement actions significantly. Healthcare entities should consider reviewing their compliance programs and billing practices in light of these announced priorities, particularly in areas susceptible to data-driven detection.