The Trump administration is intensifying its crackdown on health care fraud, with the Department of Justice issuing a clear warning to industry executives: avoid becoming the next Theranos. This month, officials announced an expanded focus on corporate wrongdoing in the health sector, alongside ongoing efforts to combat Medicare and Medicaid fraud.
Jacob Support, deputy assistant attorney general in the National Fraud Enforcement division, outlined the strategy at the STAT Summit in Boston. He emphasized the importance of companies self-reporting potential criminal activity and encouraged whistleblowing.
“There’s nothing more that we want to know when a compliance failure occurs than to hear about the great efforts to remediate it, and reward that,” Support said.
The department is consolidating voluntary self-disclosure filings under its health care fraud section. Companies previously faced a separate process with the Department of Health and Human Services. They will now find a “one-stop shop” at the DOJ, Support assured.
This change offers a significant incentive: companies reporting potential misconduct can benefit from limited financial liability caps from both agencies simultaneously.
The DOJ’s health care fraud section has expertise in emerging areas like digital health technology. It will use data analytics and artificial intelligence to identify fraud, including billing for unnecessary services, falsified patient records, and redundant diagnoses by health tech companies.
An October 1 memo from Assistant Attorney General Colin M. McDonald highlights the use of social media, news reports, and other sources to identify potential violations. The department is also developing programs to encourage whistleblowers.
Prosecutors will prioritize cases involving health care schemes, controlled substances, and violations of the Food, Drug, and Cosmetic Act. They’ll consider factors like executive knowledge of fraud, scheme duration and scope, and impact on taxpayer-funded programs.
Support highlighted the bipartisan nature of the fight against fraud: “These cases not only involve the theft of all of our tax dollars, [but] involve the theft from a program, a trust fund, Medicare, that could run out.”
