DOJ’s Criminal chief outlines health care fraud fight

By instituting “a brand-new strategy to respond flexibly and quickly to fraud,” the Criminal Division of the U. S. Department of Justice has had “remarkable success” responding to the pandemic and changes in the implementation of health care, said Kenneth A. Polite Jr., assistant attorney general of the Criminal Division in a keynote address to the Washington Health Law Summit on Dec. 6-7 in Washington, D.C.

Among the achievements he discussed were:

• Prosecution of five law enforcement actions worth $8 billion in telehealth fraud in the last three years. Telehealth usage spiked across the country during the pandemic and helped bridge the gap between patients and care providers, but “bad actors” were able to gain access to a much wider population of patients to exploit, Polite said. “These prosecutions are succeeding and are sending a clear deterrent signal to wrongdoers.”
• Criminal charges brought in May against 14 defendants in seven federal districts for $143 million in false billings.
• Creation in 2020 of a Sober Homes Initiative, “the very first coordinated enforcement action in DOJ history focused on broad schemes in the substance-abuse treatment industry,” Polite said. In this effort, the Health Care Fraud Unit goes after medical providers that feed patients’ addictions in order to continue billing for their “recovery.” Several prosecutions have come out of the initiative, with the most recent in November when the owners of one such facility were convicted after a seven-week trial and are awaiting sentencing.
• Creation of the fraud unit’s National Rapid-Response Strike Force, staffed by prosecutors from across the country who are using data analytics to identify and prosecute individual and corporate actors in health care fraud.

“Continued change is a near certainty” and as health care evolves, so will fraud schemes, Polite said, and DOJ will “spare no effort” to go after them.

In the other keynote, Gregory E. Demske, chief counsel to the inspector general, and Lisa M. Re, assistant inspector general for legal affairs, both with the Office of Inspector General at the Department of Health and Human Services, discussed federal enforcement and regulatory activities in their area.

Other programs at the summit included discussion of the No Surprises Act (which is aimed at eliminating unexpected medical bills) and pricing transparency, the trend in recognizing LGBTQ rights in long-term care, and the future of health care privacy.

Related links:

• Health Law Section
• ABA Journal:
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