On June 29, 2021, during the American Health Law Association’s Annual Meeting, Deputy Assistant Attorney General for the Department of Justice’s (DOJ) Civil Division Michael Granston provided statistics concerning DOJ’s enforcement of False Claims Act violations in the healthcare industry.  Granston stated that DOJ had “opened over 900 new matters in 2020, including 580 new health fraud matters.”  So, 64% of all DOJ civil matters involve some sort of healthcare fraud.  Granston added that 265 of the 366 False Claims Act cases DOJ settled in 2020 involved the healthcare industry.  DOJ released its False Claims Act Statistics for Fiscal Year 2020 in January, disclosing that False Claims Act recoveries in cases involving healthcare fraud totaled more than $1.8 billion last year. Even assuming some of the recovery comes from cases that went to trial, the total recovery compared to the number of False Claims Act matters settled demonstrates the significant financial implications of False Claims Act investigations.

Granston went on to highlight various areas of focus for DOJ going forward.  The first area of focus is fraud that impacts the current opioid crisis.  The opioid crisis is one of the few issues that transcends party lines, and both parties have indicated that combatting the crisis is a priority.  Given the widespread support for these efforts, it is no surprise that fraud impacting the opioid crisis is an area of focus for DOJ.  The second area of focus is fraud in connection with the various COVID relief funds.  Shortly after COVID-19 relief funds began to accept applications, the government began to investigate allegations of fraud, and in the time since, DOJ has indicted numerous individuals – like in this case and this case previously reported by Chilivis Grubman attorneys.  Given the volume of funds distributed via Paycheck Protection Program loans and COVID-19 Economic Injury Disaster Loans, it is expected that investigations and prosecutions will continue for the next few years.  Granston added that senior citizen abuse, electronic health record misuse, and manipulation of the Medicare managed care program were other areas of focus.

Given the prevalence of healthcare fraud investigations and the wide range of healthcare issues upon which DOJ intends to focus its enforcement efforts, it is more important than ever that those operating in the healthcare industry implement effective compliance programs.  If served with a DOJ subpoena or CID, those companies need to engage attorneys with experience in healthcare fraud investigations.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with False Claims Act investigations and qui tam litigation.  If you need assistance with such a matter, please contact us today.