Two Chiefs, One Message: DOJ Turns Up the Heat on Health Care Fraud

A Sunday fireside chat with two of the U.S. Department of Justice (DOJ)’s frontline unit chiefs made it clear where federal health care enforcement is heading. This moderated panel featured Jacob Foster, Chief of the Criminal Division’s Health Care Fraud Unit, and Kate Payerle, Chief of the newly created Health & Safety Unit. The recurring refrain: DOJ is letting the data take the lead.

A Bigger, Data-Driven Health Care Fraud Unit

Foster framed the Health Care Fraud Unit’s mission as prosecuting the largest, most impactful health care fraud cases. DOJ’s signature Strike Force model began in Miami in 2007 and now spans eight (soon to be nine) Strike Forces nationwide. What’s new is the scale and structure: as we previously covered on Enforcement Edge, the Unit now sits within DOJ’s new National Fraud Enforcement Division, part of a more centralized, “whole-of-government” approach to fraud.

The data guides DOJ’s priorities. Foster cited the new West Coast Strike Force — in Arizona, Nevada, and Northern California — as following analytics that flagged a migration of fraud schemes into the region. He touted the Health Care Fraud Unit’s reported $106-to-$1 return on investment, bipartisan support across administrations, and a targeted increase in prosecutors for Medicaid fraud. DOJ is increasingly coordinating with the states, too, with a clearer division of labor: the feds focus on corporate actors and high-dollar cases, the states on patient abuse and identity theft. The throughline is a “laser focus” on corporate prosecutions and individual executive accountability.

Foster also described DOJ’s Health Care Fraud Data Fusion Center — its first data intelligence hub — which unites DOJ, CMS, and HHS-OIG to spot anomalies in real time, even by mining consumer complaints and online reviews beyond claims data. For providers, the takeaway is sobering: a statistical outlier may draw scrutiny long before any whistleblower surfaces.

A New Unit on the Block: Health & Safety

Payerle introduced the Health & Safety Unit, which focuses on criminal conduct that harms consumers and was spun out of the former Consumer Protection Branch. Examples of the Unit’s focus include a disease outbreak traced to a food plant or an unsafe device or drug. Because corporations act through individuals, Payerle noted, her unit will criminally investigate both. She pointed to recent Texas guilty pleas involving "poppers" — alkyl nitrites mislabeled as “tape cleaner” to evade the FDA, with more than $8 million in unlawful sales.

Interacting With the Government

Both chiefs closed with guidance that Enforcement Edge readers will recognize from DOJ’s evolving self-disclosure framework — the most recent of which is the first-ever department-wide policy announced this spring. The advice: know when it’s time for fact-sharing and engage transparently; share completely rather than in pieces; produce information timely; and be prepared to show that individuals have accepted responsibility. None of it guarantees against prosecution, but for an industry facing a larger, better-coordinated, data-driven enforcement apparatus, how you respond when something goes wrong still matters.

We’ll keep bringing coverage from New York. Stay tuned.

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