Although 2017 brought a change of Administration and with it, new lead- ership of federal agencies — including
the United States Department of Justice (DOJ)
and Health and Human Services
Opioid fraud and abuse
(HHS) — government enforcement
in healthcare remains at an all-time
high. As in past years, the federal
False Claims Act (FCA) continues
to be the most powerful tool in the
federal government’s fraud-fighting
toolkit, which is not surprising,
considering Attorney General Jeff
Session’s public statements in support
of the FCA, including during his Senate con-
firmation hearings. This article explores some
of the current top government enforcement
priorities in the healthcare industry.
Perhaps the central focus of the government’s
current enforcement activity in the healthcare
industry relates to prescribing opioids and
other narcotic drugs. The United States is in
the midst of an opioid overdose epidemic and,
according to the Centers for Disease Control
and Prevention (CDC), nearly half of all opioid
overdose deaths involve a prescription opioid.1
In July 2017, the DOJ announced the largest healthcare fraud takedown in history,
which included charges against more than 412
individuals who were allegedly responsible
for $1.3 billion in fraud losses. 2 The defendants included doctors, nurses, and other
licensed medical professionals and, of those
charged, more than 120 defendants were
charged for their alleged roles in prescribing
and distributing opioids and other dangerous
The following month, the DOJ announced
the creation of the Opioid Fraud and Abuse
Detection Unit, a new DOJ pilot program
that will focus specifically on opioid-related
healthcare fraud by using data to identify and
prosecute individuals who contribute to the
opioid epidemic. 3 The program includes funding 12 federal prosecutors who will spend
by Scott R. Grubman, Esq
The top government enforcement
priorities in healthcare:
View from the trenches
» Fraud and abuse enforcement in the healthcare industry continues to be a top priority for the federal government.
» Both the federal and state governments have focused their resources to fight the opioid epidemic, including investigating
potential fraud and abuse related to prescription opioids.
» Compounding pharmacies have remained a focus of the DOJ in both civil and criminal investigations and prosecutions.
» The DOJ and private whistleblowers continue to focus on hospice providers, leading to several large settlements in 2017.
» Large pharmaceutical companies are under scrutiny by federal authorities for violations of the False Claims Act.
Scott R. Grubman ( email@example.com) is a Partner at Chilvis Cochran
Larkins & Bever, LLP in Atlanta, GA.