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The Rise of the Travel Act
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.
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