In August, Assistant Attorney General Colin McDonald issued a memorandum (the “Memo”) announcing the enforcement priorities of the National Fraud Enforcement Division (also known as NFED), which the U.S. Justice Department (DOJ) established in April of this year.[1]
McDonald noted that NFED “has quickly established a nationwide footprint” since launching in April and that DOJ “is reorganizing substantial resources from other Department components to [NFED], which will increase [its] headcount to approximately five hundred attorneys and staff by August 24, 2026” and “will continue to rapidly grow for the next two years” with “an aggressive plan to significantly increase the number of [NFED] personnel dedicated to fighting fraud.” McDonald promised that “[NFED] prosecutors will be supported by asset recovery attorneys and investigators, top-flight appellate counsel, a dedicated privilege review team, corporate enforcement experts, automated litigation support, a cross-disciplinary team of experts in data science, and cutting-edge technology and resources.”
McDonald declared that NFED “will continue to focus resources principally on prosecuting frauds that threaten the health, safety, security, and prosperity of Americans, especially the most vulnerable among us, including children, the elderly, and the sick or disabled.” The Memo identified five areas of fraud that NFED will prioritize, including health care. Decrying the “rampant fraud on government and private insurers,” the Memo noted that “[n]ational health care expenditures are expected to grow from over $3 trillion a year to over $7 trillion, and estimates are that between 3–10% of that amount is lost to fraud.” McDonald specifically called out “[h]ome health aide and hospice scams [that] directly impact vulnerable elderly Americans and erode patient care.”
The Memo stated that NFED “will use cutting-edge data analysis to target exploitative health care fraud schemes, including in telemedicine programs, Medicare or Medicaid fraud, controlled substance diversion, home health and hospice schemes, and companies and individuals that deceptively market unsafe products and services.” The Memo went on to state that “[b]y supercharging the historically successful Health Care Fraud Strike Force model with greater resources, data analytics support, and best-in-class technology, [NFED] will prosecute the most significant cases involving health care in the United States.”
Given this renewed and aggressive focus on fraud enforcement through NFED, specifically including home health fraud, as well as the government’s infusion of additional financial resources and state-of-the-art data analytics to support that effort, the home health industry should expect greater scrutiny than ever before. Now would be a good time, with the assistance of counsel and others, to ensure that your billing practices are fully compliant and not vulnerable to potential misconduct allegations that could bring your organization within the crosshairs of federal fraud investigation.
If you have any questions about this article or how the activities of DOJ’s new National Fraud Enforcement Division could impact your organization, you may contact the author at Geoffrey.Kaiser@rivkin.com or (516) 357-3161.
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