Medicare Fraud Takedown Touted as Largest in Strike Force History

The U.S. Department of Health and Human Services (HHS), its Office of Inspector General, the Federal Bureau of Investigation, and the Justice Department's Criminal Division announced a nationwide "takedown" of 243 individuals in connection with an alleged Medicare fraud scheme involving more than $700 million in false billings. The individuals charged include 46 doctors, nurses and other licensed health care professionals. "This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and the loss amount," according to an HHS press release. "This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets," said HHS-OIG Inspector General Daniel R. Levinson in the release. "Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes."

The Affordable Care Act is credited with providing new enforcement resources and $350 million in funding that financed additional prosecutors and expanded Strike Force activities enabling enforcement initiatives such as this takedown. Assistant Attorney General Leslie R. Caldwell also explained in the release how the Department of Justice has become "more strategic" in finding and prosecuting fraud: "We obtain and analyze billing data in real time. We target hot spots—areas of the country and the types of health care services where the billing data shows the potential for a high volume of fraud—and we are speeding up our investigations." For discussion of Caldwell's prior comments on new strategies for fighting fraud, see the May 28, 2015 issue of National Intelligence Report.

The allegations in this case include anti-kickback violations, money laundering and aggravated identity theft relating to home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs. The government alleges that the individuals charged billed for equipment, care and services not actually provided. Those charged include 78 people in Florida, 29 in Texas, eight in Los Angeles, nine in New York, 11 in New Orleans, and 16 in Detroit. While the cases involve allegations only at this point and must be proved in court, with these new charges, the Department of Justice said national takedown operations to date have yielded charges for over 900 individuals and involved more than $2.5 billion in billings.

This latest takedown emphasizes the increased attention and resources devoted to health care fraud enforcement efforts and prosecution of physicians and other individuals in addition to large organizations. "In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives," said Attorney General Loretta E. Lynch in the DOJ statement.

Takeaway: Fraud enforcement continues at a brisk pace utilizing the advantages of current technology and targeting not just large organizations but individual professionals as well.