Recent Decision Underscores Need for Involvement of Counsel in Internal Investigations

In a conversation with Lee Pacchia from Mimesis Law, Foley & Lardner Partner, Lisa Noller, discusses the Government’s approach to health care fraud prosecutions and what companies can expect in 2015.

Since 2007, the Department of Justice (DOJ) has increased its affirmative civil and criminal enforcement priorities. Rather than relying on whistleblowers to come forward and make a complaint, the DOJ now actively reviews its claims and other statistical data, using fiscal intermediaries to analyze denials of claims, sending third party contractors to conduct on-site surveys and increasing the use of wiretaps. These tools are in addition to reviewing all whistleblower complaints for potential criminal cases, and more traditional methods of law enforcement such as wire taps and patient interviews. Congress also has significantly increased funding to combat fraud and abuse.

With more coordination among administrative, civil and criminal agencies, the DOJ’s health care fraud prosecutions are up 75% since 2007, and in 2014 alone, netted the Government more than $2.3 billion.

In 2015, regulatory changes and developments likely will revolve around continued ACA implementation, the Sunshine Act and the 60-Day Refund Rule. And of course, traditional methods of criminal enforcement will continue.