Launch of the Criminal Division’s In-House Health Care Data Analytics Team

by Dickinson Wright
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Dickinson Wright

In its “2017 Year in Review” (https://www.justice.gov/criminal- fraud/file/1026996/download), the Fraud Section in the Criminal Division of the US Department of Justice announced the launch of its Health Care Fraud Unit’s Data Analytics Team. While the use of data analytics is not new to the Department of Health and Human Services and civil enforcement section of the Department of Justice, the addition of an in-house data analytics team as part of its official structure for criminal prosecutions is significant.

The Data Analytics Team will assist prosecutors on two fronts: (1) identifying individuals and entities for prosecution and (2) learning about emerging health care fraud trends. Notably, the Team will train U.S. Attorney’s Offices on customized fraud data analytics. Among many other things, you can expect the Data Analytics Team to play a big role in specific public health issues such as the opioid epidemic.

If your compliance department does not currently use data analytics as part of its risk assessment and compliance program effectiveness review, it is behind the game. Compliance departments should include data analytics in its annual plan and use all data available to it as an integral part of its compliance toolbox.

The use of data analytics is not strictly limited to health care. For example, the Securities and Exchange Commission has embraced the use of data analytics in its investigations for approximately a decade and touts the value of its analytics tools in foundations for successful enforcement actions. However, as a result of both a vast availability of health care data and wide-range of health care expertise, the health care fraud unit is ahead of the other Federal units in utilizing data analytics particularly as part of its official structure. The launch of this Team represents a continued recognition of the significance of data analytics and positions the Fraud Unit ahead of the game.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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