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DOJ and VA-OIG Announce New Veterans Affairs Healthcare Fraud Task Force

On October 1, 2019, the U.S. Department of Justice (DOJ) Office of Public Affairs announced that the DOJ and the Department of Veterans Affairs Office of Inspector General (VA-OIG) have established a new joint task force that will focus specifically on targeting VA healthcare fraud. It is known as the Veterans Affairs Healthcare Fraud Task Force. According to the DOJ’s press release:

“The [Veterans Affairs Healthcare Fraud] Task Force combines VA-OIG’s substantial experience investigating healthcare fraud at VA with the Justice Department’s proven track record prosecuting healthcare fraud through its Medicare Fraud Strike Force, which resides within the Criminal Division’s Fraud Section. The Task Force initially will focus on investigating and prosecuting healthcare fraud in VA’s growing Community Care program, under which eligible veterans may receive healthcare from a private provider in their community (rather than from a VA medical facility), similar to the Medicare program.”

The DOJ’s press release quotes an Assistant Attorney General from the Department’s Criminal Division as stating that the new Veterans Affairs Healthcare Fraud Task Force, “leverages the proven success of the Department’s Strike Force model.” This is a reference to the DOJ’s Medicare Fraud Strike Force, which has been in operation in cities around the country since 2007, and which has been directly responsible for numerous prosecutions of healthcare providers and other entities (such as durable medical equipment (DME) distributors and telemedicine companies) suspected of fraudulently billing the federal government.

New Veterans Affairs Healthcare Fraud Task Force Will Target “Community Care” Providers

The Veterans Affairs Healthcare Fraud Task Force’s primary task will be to target private healthcare providers who treat veterans under the VA’s new Community Care program. The Community Care program was created by the VA MISSION Act in June 2019 in order to provide veterans with access to care from approved non-VA healthcare providers. Under the Community Care program, private healthcare providers bill the VA similar to billing Medicare, Medicaid, or Tricare.

As a result, while the program provides new opportunities for veterans and healthcare providers alike, it also provides a new opportunity for fraud artists to take advantage of a highly-complex multi-billion-dollar federal benefit program. For this reason, the DOJ and the VA are trying to be as proactive about combatting fraud under the Community Care program as possible. According to a VA Inspector quoted in the DOJ’s press release:

“[T]his is one of those rare opportunities . . . where we can . . . get ahead of the curve by partnering with the [DOJ] and leveraging its proven strategies for combating fraud in the Medicare program. This Task Force sends a clear message to anyone considering committing healthcare fraud at VA – we will protect our veterans’ healthcare system at all costs.”

Unfortunately, while the risk of intentional fraud makes federal law enforcement efforts like the Veterans Affairs Healthcare Fraud Task Force a necessity, it also means that legitimate healthcare providers who do their best to comply with the law are at risk for investigation and prosecution as well. In the short time since the creation of the VA’s Community Care program, we have already seen a dramatic increase in VA healthcare fraud investigations. Unintentional billing violations are characterized as a form of “fraud” under the False Claims Act; and, with the DOJ’s heavy reliance on data analytics, intentional and unintentional billing violations have equal opportunity to trigger invasive and potentially dangerous federal investigations.

VA Healthcare Fraud Allegations Can Take Many Different Forms

Similar to other types of federal healthcare fraud investigations, the Veterans Affairs Healthcare Fraud Task Force is targeting a broad range of fraud-related allegations. In addition to targeting providers’ and other companies’ VA billing practices, federal agents and prosecutors are closely scrutinizing these entities’ financial relationships as well. Common issues being targeted in VA healthcare fraud investigations include:

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Examples of Recent Veterans Affairs Healthcare Fraud Task Force Cases

Despite being publicly announced on October 1, 2019, the Veterans Affairs Healthcare Fraud Task Force has already taken part in several “takedowns,” working in cooperation with the Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Internal Revenue Service (IRS) Criminal Investigations Division. Examples of the Veterans Affairs Healthcare Fraud Task Force’s early enforcement efforts include (Oberheiden, P.C. did not represent the defendants in any of these cases):

1. Compounding Pharmacy Fraud Involving “Unnecessary and Expensive Creams”

According to the DOJ’s press release, the Veterans Affairs Healthcare Fraud Task Force participated in a recent investigation targeting a compounding pharmacy and related entities and individuals who allegedly billed the Department of Labor-Office of Worker’s Compensation and Blue Cross Blue Shield for “unnecessary and expensive creams” provided to VA employees. Similar to opioid fraud, compounding pharmacy fraud has seen a recent resurgence in federal law enforcement activity, with federal agents and prosecutors frequently questioning the legitimacy and medical necessity of compound creams and similar types of medications.

2. Alleged Kickback Scheme Involving More than $510 Million in Illegal Payments

The DOJ’s press release also indicates that the Veterans Affairs Healthcare Fraud Task Force recently participated in a federal healthcare fraud investigation involving more than $510 million in alleged illegal reimbursements from Tricare-reimbursed funds. According to the press release, the defendants are facing multiple criminal charges under the Anti-Kickback statute and various other federal laws.

Have You Been Contacted by the Veterans Affairs Healthcare Fraud Task Force?

If your business or practice bills the VA under the Community Care program and you have been contacted by federal agents from the DOJ or the VA-OIG, it is important that you seek experienced legal representation immediately. Federal healthcare fraud investigations can progress quickly, and you need to try to protect yourself against being charged if at all possible.

At Oberheiden, P.C., our attorneys have centuries of combined experience on both sides of federal healthcare fraud investigations. Our attorneys have collectively handled thousands of federal cases, resolving the vast majority of these cases without any civil or criminal liability for our firm’s clients. Meet the attorneys on our federal healthcare fraud defense team.

Contact Us 24/7 for a Free and Confidential Case Assessment

We represent clients in need of qui tam defense, involved in False Claim Act investigation, facing federal criminal charges, and in other legal matters.

For more information about how we defend healthcare providers and other individuals and entities during VA healthcare fraud investigations, call 888-680-1745 or contact us online for a free and confidential case assessment. Our attorneys are available to speak with prospective clients nationwide 24/7.

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