DOJ & HHS Centralize Healthcare Fraud Enforcement
The DOJ Fraud Division becomes the single point for self‑disclosures, while CMS gains a broader authority to exclude cases.
The Department of Justice’s Fraud Division has been designated as the sole contact point for all self‑disclosure requests related to potential criminal healthcare fraud. This change streamlines the submission process, making it clearer for healthcare providers, payers, and suppliers to report suspected fraud. Simultaneously, the Centers for Medicare & Medicaid Services (CMS) has been granted permissive exclusion authority, allowing it to exclude certain issues from its own audit scope when the DOJ is already pursuing a criminal case. Together, these measures create a coordinated front for criminal enforcement, reducing duplication of effort and aiding firms in aligning their compliance and litigation strategies with the new enforcement protocol. Counsel should review client practices to ensure self‑disclosure procedures are updated and that CMS exclusion guidelines are understood to avoid potential over‑reach or gaps in coverage.