Department of Justice Brings HEAT to New Jersey in the Form of the Medicare Fraud Strike Force

On Monday, August 13, 2018, the United States Justice Department (DOJ) announced the formation of the Newark/Philadelphia Regional Medicare Fraud Strike Force (Regional Strike Force), a successor to the Health Care Fraud Prevention & Enforcement Action Team (HEAT).

The HEAT Strike Force has been focusing its efforts on 10 cities across the United States including Miami, Los Angeles, Detroit, Houston, Brooklyn, Baton Rouge, New Orleans, Tampa, Chicago, and Dallas. The Strike Force recently was credited with the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud alleged schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

The Regional Strike Force will be made up prosecutors from various agencies including the FBI, OIG and DEA. The Strike Force will focus its efforts on aggressively investigating and prosecuting cases involving fraud, waste, and abuse within federal health care programs, and cases involving illegal prescribing and distribution of opioids and other dangerous narcotics.

Recent enforcement actions combined with the announcement of a Regional Strike Force in New Jersey is yet a further wake-up call for providers engaged in both medical and pharmaceutical activities to review their strategic relationships and day-to-day operations for compliance with federal and state law, particularly anti-kickback, false claims, and Controlled Substance Act. Of particular concern is any arrangement between referral sources and providers, such as physician-pharmacy, pharmacy-manufacturer, and marketing company-telehealth provider. Prescribers of opioids and participants in the prescription drug supply chain (e.g. manufacturer, wholesaler, distributor, pharmacy, etc.) should implement strict controls consistent with federal and state controlled substance laws, DEA/Diversion Control Manual, as the DOJ is not limiting its enforcement to traditional fraud and abuse activities, but will also be targeting actors, such as physicians and drug distributors, that the government feels are contributing to the opioid epidemic.

Contact Frier Levitt today for help avoiding regulatory issues. Frier Levitt’s team of over 30-healthcare attorneys, including clinician-attorneys, are experienced in guiding healthcare providers through the complex web of healthcare law and regulations.