DOJ, CMS Announce New Data-Sharing Programs in Indiana and Ohio, Looks to Ramp Up Fraud Enforcement in the Midwest

Dominick S. Gerace II, the United States Attorney for the Southern District of Ohio, and other top officials of the Department of Justice (DOJ) and Centers for Medicare & Medicaid Services (CMS) announced a new federal-state data-sharing initiative to ramp up healthcare fraud enforcement in the Midwest at a press conference on June 5 in Columbus, Ohio.

This announcement comes as part of the federal government’s “CRUSH” (Comprehensive Regulations to Uncover Suspicious Healthcare) program, a major anti-fraud effort that focuses on advanced data analytics to uncover and pursue fraud schemes.

During the press conference, Dr. Mehmet Oz, CMS Administrator, explained that the federal government is undertaking a nationwide effort to audit state Medicaid systems. Through this audit, the federal government will identify shortcomings in state enforcement and develop best practices by comparing and analyzing data among surrounding states.

As part of that push, Oz announced the state of Indiana has agreed to work with Oracle Health to provide specific sets of Medicaid data to facilitate this initiative. Oracle Health released a parallel announcement about the arrangement. Under this federal-state partnership, Oracle’s data intelligence services will be used to analyze Indiana claims data and identify potential fraud in the Medicaid system. This data will then be used as part of the federal government’s audit of other state Medicaid systems.

Officials also announced that Ohio Secretary of State Frank LaRose has executed a data-sharing agreement that provides DOJ’s Fraud Division with access to corporate registrant data held by the state of Ohio. DOJ intends to use this data to conduct proactive data analysis to identify ownership links between clinics and healthcare providers that the government says are used by fraudsters to cover up healthcare fraud.

DOJ and CMS leaders took the opportunity to call out specific areas in Ohio and Indiana that have caught the attention of federal regulators. In particular, Oz highlighted concerns about autism treatment providers in Indiana that offer applied behavioral analysis (ABA) therapy. ABA has been the subject of high-profile national media attention in recent months, and recently Indiana’s Family and Social Services Administration announced that it will halt enrollment of new providers for at least six months while this issue is investigated. Oz said that ABA therapy has been “scandalously abused” and announced that CMS intended to go after ABA therapy providers for the alleged fraud.

While DOJ is looking to combat healthcare fraud across the nation, these data-sharing initiatives point to increased enforcement activity in Ohio and Indiana in the near term. Healthcare providers in the Midwest should anticipate heightened scrutiny and proactively review billing practices and compliance programs to get ahead of this government enforcement.

Barnes & Thornburg's White Collar, Compliance & Investigations team includes Josh Minkler, former U.S. Attorney for the Southern District of Indiana; David DeVillers, former U.S. Attorney for the Southern District of Ohio; former Assistant U.S. Attorneys; and experienced trial and compliance counsel who help healthcare entities navigate healthcare fraud investigations, False Claims Act matters, payor/provider disputes, compliance matters, and enforcement actions.

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