TAX FRAUD.
Hospice News: Healthcare Fraud Strike Force.
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HEALTHCARE, THE DOJ #1 TARGET.
RISK MANAGEMENT: PROTECT YOURSELF FROM FCA (CIVIL) AND CRIMINAL EXPOSURE.
The DOJ has launched the West Coast Health Care Fraud Strike Force, which collaborates with U.S. Attorney’s Offices in Arizona, Nevada, and Northern California, along with the DEA and FBI. This initiative aims to tackle increasing healthcare fraud by using data analytics to identify fraud across these states. Assistant Attorney General Colin McDonald stated that the Strike Force has already led to the prosecution of over 6,200 defendants linked to more than $45 billion in fraudulent claims.
- The new West Coast Strike Force will have health care prosecutors backed by a $300 million grant for federal fraud enforcement. With the DOJ’s expertise in data analytics and coordination, this investment will significantly boost enforcement efforts by increasing scrutiny and the number of investigations into industry fraud.
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Their Target.
- Medical Device and Wound Care Companies: After the conviction of two wound graft company owners in Arizona, the DOJ will use data analytics to target companies suspected of fraudulent billing, including medically unnecessary applications, illegal kickbacks, and upcoding.
- Substance abuse treatment. The Department of Health and Human Services (HHS) has also joined this effort, emphasizing the importance of collaboration among federal enforcement agencies. Acting Deputy Inspector General Scott Lampert noted the model’s effectiveness in identifying and prosecuting fraud through a coordinated approach.
- Digital technology. Enforcement efforts have expanded to tackle fraud in the digital health sector, particularly involving telemedicine and illegal online distribution of controlled substances. The Northern District of California, as a hub for health tech, enables prosecutors to effectively pursue emerging fraud schemes in the region.
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FRAUD TAX PROJECT.
In addition to the Strike Force, HHS and CMS are working together on the Fraud Tax Project to combat health care and tax fraud. California, identified as a fraud hotspot, has implemented a moratorium on new hospice enrollments and revoked over 280 licenses for new operators in the past two years. Investigations in California have revealed numerous fraudulent operators exploiting the system.
- The need for more investigative resources was highlighted by Hilary Loeffler of the National Alliance for Care at Home, who suggested that better targeting, rather than new regulations, is needed to effectively address fraud.