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The U.S. Department of Justice (DOJ) continues to prioritize health care anti-fraud enforcement through the aggressive use of different statutes and investigative methods. Although the prosecutions and recoveries vary, between October 2016 and March 2017, “Strike Force” team efforts led to charges against 49 individuals or entities, 152 criminal actions, and more than $266.8 million in investigative receivables. Semiannual Report to Congress, U.S. Dep’t of Health & Human Services: Office of Inspector General: Oct. 1, 2016 to Mar. 31, 2017, http://bit.ly/2jaG6VP. Attorney General Jeff Sessions recently reaffirmed his interest in keeping health care fraud as a priority, and followed up those comments with the largest ever DOJ national health care fraud takedown, involving charges against 412 persons, including physicians.
Health care anti-fraud enforcement initiatives traditionally focus on cases involving Medicare and Medicaid fraud. The reason is clear: recovery of government-funded money. More than half of the estimated expenditures in health care fraud overall are against public health care programs. For that other half, there has been another approach to combat health care fraud in which the government often uses the federal mail and wire fraud statutes; one of HIPAA’s specialized mail and wire fraud provisions tailored to health care fraud; or 18 U.S.C. § 1347, which makes it a crime to knowingly and willfully execute a scheme to defraud a health care benefit program, whether that program be public or private.
Recently, a new tactic has emerged. The government is putting a 60-year-old tool to a new use. It is using the federal Travel Act to pursue criminal charges against health care entities in connection with health care bribery/kickback schemes. The courts have yet to rule on the viability of such charges. This article discusses these recent actions and the potential ramifications of the expansion of the scope of the Travel Act.
The Origins of the Travel Act
Enacted in 1961, the Travel Act was the centerpiece of then Attorney General Robert F. Kennedy’s war on organized crime. Its original purpose was to stem the clandestine flow of profits from organized crime and to assist states in combating criminal activities that crossed state lines. U.S. v Nardello, 393 U.S. 286, 292 (1969). The Travel Act targeted persons who lived in one state while operating or managing illegal activities located in another. Rewis v. U.S., 401 U.S. 808, 811 (1971).
The Travel Act provides that:
(a) Whoever travels in interstate or foreign commerce or uses the mail or any facility in interstate or foreign commerce, with intent to—
(1) distribute the proceeds of any unlawful activity; or
(2) commit any crime of violence to further any unlawful activity; or
(3) otherwise promote, manage, establish, carry on, or facilitate the promotion, management, establishment, or carrying on, of any unlawful activity.
By Jacqueline C. Wolff
Lessons Learned from Recent Settlements and Decisions
Health care fraud and False Claims Act cases continue to generate a significant source of funds for the Federal Government. Although, when announcing its focus, the government listed treatment options are not always clear. What these settlements often have in common is that the underlying complaints allege that the services that were rendered and reimbursed lacked medical necessity.
By Robert J. Anello and Justin Roller
Part Two of a Two-Part Article
Though they might seem straightforward on their faces, limitations periods are often elongated by legislation or court interpretation. The authors began looking at some of these exceptions to the stated limitations periods last month in Part One of this article. They continue here with further examples.
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