The Trump administration’s crackdown on fraud, waste and abuse continues, with the Department of Justice last week launching a new effort targeting healthcare fraud.
The DOJ rolled out a strike force targeting healthcare fraud in Arizona, Nevada and Northern California. The new strike force — which the DOJ is calling its “West Coast” healthcare fraud strike force — comes seven months after the department launched a similar strike force going after healthcare fraud in Massachusetts. Florida is not on this list yet, even though it has a reputation for healthcare fraud, but it might be next.
Experts think the new strike force reflects the federal government’s broader effort to adapt its fraud enforcement to industries that are becoming more data-driven and tech-enabled each day.
Why these regions?
The new West Coast strike force is an expansion of a longstanding enforcement model that…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.