Beyond any changes to the Affordable Care Act, the fraud enforcement agenda could change with the arrival of a new administration with new department heads who carry different concerns.
There is often a restructuring of fraud priorities with any new administration, but there are even more unknowns with Donald Trump, says Dennis Jay, executive director of the Coalition Against Insurance Fraud.
“We’re in a great unknown area right now as far as whether healthcare fraud is going to have the priority that it has achieved over the last few years,” Jay says, noting that many fraud-enforcement programs are “really starting to hit their stride.”
Outside of the ACA, President Barack Obama's administration put tremendous emphasis on fraud enforcement through the creation of the Health Care Fraud Prevention and Enforcement Action Team in 2009 and the expansion of the Medicare Fraud Strike Force to eight new cities.
Gejaa Gobena, a partner with Hogan Lovells and who worked for the Justice Department during the George W. Bush and Obama administrations, says both presidents were intent on prosecuting fraud, but Obama ushered in a renewed focus on antifraud efforts.
“Even when it shifted to Republican-controlled Congress, there was still a strong effort to make sure healthcare fraud efforts were fully funded,” he says.
Although a changing of the guard doesn’t typically have a major impact on fraud enforcement compared to other, more partisan issues, new assistant attorney generals in both the civil and criminal division will set the enforcement priorities for the next four years, which trickles down to the state level.
“Whoever the next attorney general is, they will have a major impact on what the priorities are for the local U.S. Attorneys' offices,” says Jeff Schroder, an attorney with Plunkett Cooney and the former Assistant Attorney General for Michigan’s healthcare fraud division.