Justice Dept. to start fast-tracking benefits fraud enforcement

The federal government plans to speed up the review of certain whistleblower complaints related to fraud against benefit programs like Medicare, federal officials told CBS News exclusively Wednesday.

The officials said the move will help to fast-track fraud enforcement, a Trump administration priority.

The U.S. Department of Justice reviews whistleblower complaints made under the False Claims Act, which is the main federal statute used to fight cases of alleged fraud against government programs, including Medicare and grants. These programs are federally funded and administered by states. 

Now, the DOJ Civil Division says it will prioritize these complaints to decide if it will continue with litigation, investigate further or dismiss within a 60- to 120-day window. 

Sources said it is unusual to make a decision to decline a claim in less than 120 days. DOJ says it is working to provide CBS News with more information on the current timeline for decisions on cases that move forward.

Many of these cases start as complaints, known as qui tam actions, made by private individuals, who are also called relators. After the initial review, the Department of Justice will either allow the relator to continue with the litigation, investigate further or decide the complaint should be dismissed.

“These reforms will empower the Department to move quickly on meritorious qui tam cases, maximize finite enforcement resources, and focus on dismantling sophisticated fraud schemes that exploit taxpayer-funded programs,” DOJ said in a release shared with CBS News.

If a claim is successful, the person who reported it can receive a significant share of the government’s recovery of the fraudulently obtained benefits.

“By accelerating review of qui tam complaints alleging benefits fraud, we can more rapidly identify and disrupt emerging schemes, strategically deploy enforcement resources to recover taxpayer money, and strengthen the government’s broader fight against fraud,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division.

The Trump administration has named targeting fraud one of its key priorities, leading to several press conferences and announcements on the issue. Republicans and Democrats have traded barbs about who is responsible for creating circumstances that allow for fraud and who is doing more to fix it.

In April, the Department of Justice announced the creation of the Fraud Division. Mr. Trump has also established a task force, chaired by Vice President JD Vance, focused on eliminating fraud. Healthcare fraud, particularly in the hospice and home healthcare space, has been a particular target for the administration. 

The state of California has also established a fraud task force, where multiple agencies focus specifically on hospice fraud schemes.

CBS News has been investigating hospice fraud for months. One investigation examined the business and financial records of every hospice currently operating in Los Angeles County, applying the same indicators identified by state auditors as potential red flags for fraud. The analysis revealed that over 700 of the roughly 1,800 hospices in L.A. County trigger multiple red flags for fraud as defined by the state.

California attorney general Rob Bonta says his office has brought criminal fraud cases against more than 100 defendants in the hospice industry and about two dozen civil cases. 

Also in April, Republicans in Congress held a hearing on Capitol Hill, during which two of the people featured in the CBS News reporting were called to testify.