There may be more criminal cases involving healthcare fraud in the near future, as the U.S. Department of Justice has announced it will be ramping up its review of whistleblower cases involving alleged health care fraud.  In a recent speech Leslie R. Caldwell, Assistant Attorney General for the DOJ’s Criminal Division, announced that the U.S. Department of Justice was further ramping up its review of False Claims Act lawsuits, with special attention being paid to cases involving claims of health care fraud.
So what’s new?  First, the Criminal Division is putting more resources into reviewing cases for potential criminal investigation and prosecution.  The Criminal Division has a Health Care Fraud Unit staffed with 40 attorneys (almost half of the attorneys in the Fraud section), which Ms. Caldwell describes as “the largest and most prolific unit of criminal prosecutors dedicated solely to health care fraud in the country.”
The Criminal Division will now immediately see all of the qui tam or whistleblower actions filed as soon as the Civil Division sees them.  As reported by Mark Jacoby for MainJustice, this new, streamlined process may yield quicker parallel criminal investigations.
In addition, Ms. Caldwell’s remarks began and ended with an invitation to the members of Taxpayers Against Fraud Education Fund, a non-profit funded by successful whistleblowers and their lawyers.  “[W]hen you are thinking of filing a qui tam case that alleges conduct that potentially could be criminal, I encourage you to consider reaching out to criminal authorities, just as you now do with our civil counterparts in the department and the U.S.  Attorney’s Offices,” Caldwell said.
What to expect going forward?  The DOJ will continue its own efforts in the nine Strike Force cities (Baton Rouge, Brooklyn, Chicago, Dallas, Detroit, Houston, Los Angeles, Miami and Tampa) as well as identifying fraud by crunching CMS data.  But Caldwell also expressed the Criminal Division’s interest in looking harder and sooner at whistleblower and other actions against physicians, executives, hospitals, and healthcare companies of all types as part of its expanding focus on healthcare fraud.