The U.S. Attorney’s Office for the Northern District of New York has recently hired a new Assistant Attorney (AUSA) dedicated to pursuing recoveries of health care overpayments and fraudulent claims. In a 30,000 square-mile upstate region, encompassing areas from Binghamton to Plattsburgh and from Albany to Syracuse, the AUSA will now supplement – not supplant – the enforcement activities of the OMIG, OIG and MFCU.

The primary weapon in the AUSA’s arsenal is the federal False Claims Act (the FCA). Liability under the FCA can be staggering: three times the amount overpayment can be recovered. Moreover, during the pendency of an investigation, the AUSA could seek to suspend all or part of a provider’s Medicare or Medicaid payments.

At minimum, the AUSA’s involvement in the health care sector is likely to spark an increase in whistleblower activity. Under the FCA, individuals who report noncompliant activity to the government may receive a share of a recovery.

This new AUSA activity underscores the need for health care providers and suppliers to have active and effective compliance programs. Compliance programs must include, among other things, routine self-audits, sound whistleblower protections and internal reporting policies, and procedures to promptly investigate and self-report overpayments when identified.