Largest Strike Force Takedown in History Charges 300 Individuals

Nearly a year to the day after another nationwide Strike Force takedown, the Department of Justice announced last week what it says is a takedown involving “the most defendants charged and largest alleged loss amount in Strike Force history.”

While not directly involving labs, some of the allegations in this takedown are not unfamiliar to labs: submitting claims to Medicare and Medicaid for services that weren’t medically necessary or weren’t even performed, paying kickbacks for referrals or to get beneficiary information to facilitate fraudulent claims, and allowing nonqualified individuals to perform services billed to Medicare. Most of the cases involved allegations linked to home health, mental health, physical/occupational therapy, durable medical equipment, and prescription drug-related Medicare and Medicaid claims.

Here’s a rundown on the details of this takedown:

• 301 individuals charged in civil and criminal cases (includes 61 physicians, nurses and licensed medical professionals)
• $900 million in total losses alleged
• Payment suspension authority exercised by Centers for Medicare & Medicaid Services against numerous providers
• Criminal charges brought include conspiracy to commit health care fraud, anti- kickback statute violations, money laundering, and aggravated identity theft.

“While it is impossible to accurately pinpoint the true cost of fraud in federal health care programs, fraud is a significant threat to the programs’ stability and endangers access to health care services for millions of Americans,” said Inspector General Daniel Levinson in a statement. Medicare’s Fraud Strike Force took the lead, but 36 federal districts and 23 state Medicaid Fraud Control Units also participated in the enforcement initiative. In addition, 26 U.S. Attorney’s Offices were involved in bringing cases related to the enforcement effort. The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) which is a collaborative effort between the Department of Justice and the Department of Health and Human Services. Working out of nine locations, the Strike Force takes credit for charges brought against 2,900 individuals for false Medicare billing totaling over $8.9 million since it began in 2007.

“Taxpayers and Congress provided CMS with resources to adopt powerful monitoring systems that fight fraud, safeguard program dollars, and protect Medicare and Medicaid,” Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal, M.D. explained in a statement—echoing similar comments of fellow government agency heads who commented on the takedown. “The diligent use of innovative data analytic systems has contributed or led directly to many of the law enforcement cases presented here today. CMS is committed to its collaboration with these agencies to keep federally-funded health care programs safe and strong for all Americans.”

Just last June, a similarly significant nationwide health care fraud takedown was announced—including 243 individuals charged and $712 million in false billing. Health care attorney Gina L. Simms, of Ober Kaler, explained to National Intelligence Report’s sister publication, G2 Compliance Advisor at that time: “I believe that the ‘takedowns’ are designed to put health care providers everywhere on notice that the federal government has the resources to aggressively investigate and pursue fraud.” See “Compliance Perspectives: Take Heed: Strike Force Takedowns Signal Aggressive, Coordinated Fraud Enforcement,” G2 Compliance Advisor, September 2015, p. 5. Like this year’s takedown, criminal charges in the 2015 takedown included anti-kickback violations, money laundering, aggravated identity theft and conspiracy to commit health care fraud. The DOJ’s announcement of this latest takedown indicates a total of “nearly 1,200 individuals have been charged in national takedown operations which have involved more than $3.4 billion in fraudulent billings.”

Takeaway: Coordinated federal and state government enforcement continues to yield large-scale arrests and maintains pressure on providers, including labs, to step up compliance efforts.

Editors note: For tips on how labs can avoid becoming the target of these nationwide takedowns and how targeted labs should respond to such investigations, view G2 Intelligence Training on Demand recording, “Don’t Let Your Lab Become a “Take Down” Target for U.S. Law Enforcement Agencies!” featuring Gina L. Simms and Robert E. Mazer, health care attorneys with Ober Kaler. For more information, visit the Webinars and Training on Demand tab at www.g2intelligence.com or contact customer service at 1-888-729-2315.