The United States Attorney’s Office for the Northern District of West Virginia announced a renewed emphasis on health care fraud prosecutions in West Virginia as of January 19, 2022. It formed the Mountaineer Health Care Fraud Strike Force
to use a data-driven approach to uncover waste and abuse, and the task force purportedly involves several state and federal agencies. The U.S. Attorney’s Office also emphasized the importance of whistleblowers and encouraged them to report suspected fraud at the organizations where they are employed, noting that whistleblowers can collect potentially significant awards under federal qui tam provisions. The U.S. Attorney’s Office set up a hotline, email address, and mailing address for the reporting of potential fraud.
Government investigations often begin with an analysis of computer data identifying billing “red flags” and other reporting requirements. Consequently, investigations are often times well-developed by the time the organization is contacted by authorities regarding suspected fraud. Criminal, administrative, and civil penalties are all potential ramifications in health care fraud matters.