Medicare Fraud Strike Force Expands Operations

eduTrax News Service - December 21, 2009.

Medicare Fraud Strike Force Expands Operations into Brooklyn, Tampa, Baton Rouge

$61 Million in Fraudulent Billing Alleged in Indictments of Thirty Individuals in Miami, Detroit and Brooklyn

HHS and the Department of Justice (DOJ) reported that thirty people were charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, as part of the continuing operation of the Medicare Fraud Strike Force. Also, DOJ and HHS announced the expansion of Strike Force operations to Brooklyn, Tampa and Baton Rouge in three new phases of a targeted criminal, civil and administrative effort against fraud in the Medicare program.

Following the arrests of 25 individuals in Miami, four individuals in Detroit and one in Brooklyn, Strike Force agents executed four search warrants at businesses and homes in Coconut Creek, Fla.; Miami and Brooklyn. Additionally, five indictments were unsealed in Miami, Detroit and Brooklyn.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud, primarily through the use of Medicare data analysis techniques. With this most recent expansion, the Strike Force teams now operate in seven cities: Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge.

In a December 15 press release posted on HHS.gov, HHS Secretary Kathleen Sebelius states, “When President Obama took office, he promised a new commitment to cracking down on the criminals who steal billions of dollars from Medicare each year through fraudulent claims. Today, HHS and DOJ are following through on that commitment with the announcement of three new Medicare Fraud Strike Force teams in Baton Rouge, Tampa, and in Brooklyn. Along with teams already operating in Miami, Los Angeles, Houston and Detroit, these Strike Force operations will allow us to concentrate our agents and resources on the criminal hubs where we know a significant share of fraud occurs. Medicare is a sacred promise to America’s seniors and we will do everything we can to protect it. The announcement we’re making today is a significant step towards securing Medicare for seniors today and generations to come.”

Assistant Attorney General Lanny A. Breuer of the Criminal Division further states, “Medicare fraud schemes are driven by greed -- pure and simple. The people who perpetrate these crimes rob Medicare of precious dollars by fraudulently billing for made-up or unnecessary services. In Miami, Los Angeles, Detroit and Houston, the Medicare Fraud Strike Force is making significant progress against these schemes. Through the Strike Force’s proven data analysis, we are now also identifying the worst offenders in Brooklyn, Tampa and Baton Rouge, and we will continue to target Medicare fraudsters in these communities.”

The expanded Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the DOJ and HHS to focus their joint efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation. HEAT is composed of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions.

Alleged Schemes

The individuals charged in above indictments are accused of various Medicare fraud crimes, a daunting list of crimes:

• conspiracy to defraud the Medicare program
• conspiracy to launder money
• money laundering
• criminal false claims
• making false statements
• receiving kickbacks.

According to indictments, the defendants participated in schemes to submit claims to Medicare for products and services that were in fact medically unnecessary and oftentimes, never provided. Below are short descriptions of the allegations in each city.

Detroit

Defendants are alleged to have participated in a scheme whereby they paid kickbacks to patients who received instructions from the clinic owners and patient recruiters to feign symptoms to justify expensive testing, including nerve conduction studies.

Brooklyn

Two defendants are alleged to have billed Medicare for durable medical equipment, including expensive shoe inserts reserved for diabetes patients, when in fact much cheaper and over-the-counter shoe inserts were provided to beneficiaries who often did not need them.

Miami

Fifteen individuals, including doctors and nurses, are charged in connection with fraudulent claims to Medicare for home health services. In another case in Miami, individuals are charged for their various roles in running a medical clinic that purported to provide injection and infusion treatments to HIV/AIDS patients and submitted fraudulent claims Medicare for such services, which were often medically unnecessary and/or never provided.

Total Alleged Fraudulent Billings: $61 Million

Collectively, the physicians, business owners, executives and others charged in the indictments are accused of conspiring to submit approximately $61 million in false claims to the Medicare program.

Recently, in September 2009, the DOJ announced its largest fraud settlement in its history, as a result of whistleblower lawsuits that initiated investigations by HEAT. Since the inception of HEAT and Strike Force operations in 2007, more than 460 individuals and organizations have been indicted, for collectively falsely billing the Medicare program for more than one billion dollars.

Indictments, however, are merely allegations, and defendants are presumed innocent until and unless proven guilty.

To learn more about the HEAT team, go to: www.stopmedicarefraud.gov.