This third, and final, installment in the “Year in Review” series examines how criminal health care fraud enforcement has changed in the past year, including the use of non-health-care-related statutes, the focus on specific industries, and the increased number of alleged violators targeted in takedowns. This piece discusses specific cases illustrating recent trends in criminal investigation and enforcement, and provides our perspective on what new tactics and strategies employed by the federal government in these cases might mean for the future. Finally, it also considers how recent health care reform measures, such as new regulations, enhanced sentencing guidelines, and data analysis technology, will contribute to strengthening enforcement and enforcement strategies in 2012.

Criminal Health Care Fraud Enforcement Statistics Show “Bigger, Stronger, and Faster” Fraud Investigations

The government’s successes in prosecuting and winning health care fraud cases result from continued interagency collaboration such as Medicare Strike Force (Strike Force) and Health Care Fraud Prevention Enforcement and Action Team (HEAT) investigations. In press releases, the government has touted the ties between the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG), and local United States Attorneys’ Offices (USAOs) and Medicaid Fraud Control Units (MFCUs) in health care fraud investigations. Coordination among the agencies has increased in recent years. These established ties make it easier for the agencies to detect, investigate, and prosecute large-scale fraud schemes. As advanced data-mining techniques further strengthen the links between investigatory and enforcement agencies, large-scale investigations and prosecutions will become even easier for the government to pursue in the coming years.