The U.S. Department of Justice (DOJ) has reaffirmed its commitment to vigorous enforcement of the False Claims Act (FCA), with a particular emphasis on healthcare compliance. At the Federal Bar Association’s annual Qui Tam Conference (held Feb 20-21, 2025), DOJ officials highlighted key enforcement priorities, signaling areas where healthcare organizations should exercise heightened diligence.
Key Enforcement Focus Areas:
Healthcare Fraud, Including Medicare Advantage
(Part C): The DOJ continues to prioritize cases involving fraudulent activities within healthcare programs, especially Medicare Advantage. This includes scrutinizing improper coding practices and potential violations of the Anti-Kickback Statute (AKS).
Cybersecurity Enforcement: With the increasing reliance on digital systems in healthcare, the DOJ is intensifying its focus on cybersecurity compliance. Organizations are expected to adhere to robust data protection protocols and promptly report data breaches to avoid FCA liability.
Pandemic Relief Fraud: The DOJ is actively pursuing cases involving fraud related to COVID-19 relief programs, such as the Paycheck Protection Program (PPP). Over 700 cases are currently under investigation, underscoring the importance of compliance in pandemic-related funding.
Tariff and Customs Avoidance: Enforcement efforts are also directed toward illegal foreign trade practices, including tariff and customs avoidance, reflecting a broader commitment to uphold trade laws.
Implications for Healthcare Compliance:
Healthcare organizations should take proactive measures to ensure their compliance with federal regulations is in place and up to par. Here are a few tips to note:
Strengthen Internal Controls: Implement robust compliance programs to detect and prevent fraudulent activities, particularly in billing and coding practices.
Enhance Cybersecurity Measures: Adopt comprehensive cybersecurity protocols to protect patient data and comply with reporting requirements.
Monitor Relief Fund Usage: Ensure that pandemic relief funds are utilized appropriately and in accordance with program guidelines to avoid potential fraud allegations.
By focusing on these areas, healthcare organizations can mitigate risks and align with the DOJ's enforcement priorities, fostering a culture of compliance and integrity.
If you are falling short in your compliance efforts, please give us a call. We are passionate about helping practices become fully compliant!
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