DOJ Creates Fraud Division Targeting Medicare, Medicaid Fraud
In a client alert, Hall Render reports that the DOJ has issued a memorandum announcing priorities for its newly created National Fraud Enforcement Division, naming health care fraud as a top focus. The Division will prioritize telemedicine arrangements, Medicare and Medicaid fraud, controlled-substance diversion, home health and hospice programs, and marketing of unsafe or misrepresented health products. DOJ plans a more coordinated, data-driven enforcement approach, including use of large language models and AI tools to analyze unstructured records like EHR documentation, contracts, and compliance materials alongside claims and billing data. Hall Render advises providers to review compliance programs, coding/billing practices, and federal health care program submissions to reduce enforcement risk.