Health care fraud: Feds expand strike force operations

"If you think health care is expensive now, wait and see how expensive it will be when it's free."  - P.J. O'Rourke

Thirty suspects were charged yesterday in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims. The suspects were arrested as part of continuing operations by the Medicare Fraud Strike Force, comprised of agents from the Federal Bureau of Investigation and the Department of Health & Human Services.

The Departments of Justice and Health & Human Services expanded the Strike Force operations to include Brooklyn, NY,  Tampa, FL, and Baton Rouge, LA in the fifth, sixth and seventh phases of a targeted criminal, civil and administrative effort against individuals and health care providers who  fraudulently bill the Medicare program.

The Congressional Budget Office estimates up to $63 billion is distributed each year on fraudulent claims, with some experts estimating even higher losses due to waste and abuse of the government's current health care programs, Medicare and Medicaid.

"If Americans and political leaders believe there's a high-level of corruption within these two government-run medical systems, wait until the new program is in place with many more millions of Americans depending on government largess for their medical treatment," warns political strategist Mike Baker.

Federal agents arrested twenty-five suspects in Miami, four suspects in Detroit and one in Brooklyn. In addition, Strike Force agents executed four search warrants at businesses and homes in Coconut Creek, Florida, Miami 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 through the use of Medicare data analysis techniques and an increased focus on community policing. So far, Strike Force teams are operating in seven cities in the United States: Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge.

"Medicare fraud schemes are driven by greed -- pure and simple," said Assistant Attorney General Lanny A. Breuer of the DOJ's Criminal Division. "The people who perpetrate these crimes rob Medicare of precious dollars by fraudulently billing for made-up or unnecessary services."

"This case is a perfect example of how the feds should weed out corruption within the health care system. It is not just the government that is victimized; it's every American taxpayer and those who rely on Medicare or Medicaid for their very existence," said former NYPD detective and security firm CEO Sid Frances.

According to reports submitted to the Fraud Committee of the National Association of Chiefs of Police, the Strike Force operations in Brooklyn, Tampa and Baton Rouge are another important step of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), an anti-crime program announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation.

The HEAT taskforce is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Eric Holder and Secretary Kathleen Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

However, some law enforcement experts believe this latest series of arrests may only be a "dog and pony show to prove to Americans that the Obama Administration is serious about curtailing health care fraud and abuse while both houses of Congress are pushing a health care bill."

The 30 Individuals charged in yesterday's indictments are accused of various Medicare fraud crimes, including conspiracy to defraud the Medicare program, conspiracy to launder money, money laundering, criminal false claims, making false statements and receiving kickbacks.

According to the NACOP report, the defendants participated in schemes to submit claims to Medicare for products and services that were in fact medically unnecessary and oftentimes never provided.

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

In Brooklyn, the 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 didn't need them.

In Miami, 15 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.

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

Each of the Strike Force teams is led by a federal prosecutor from the respective U.S. Attorneys' Office or the Criminal Division's Fraud Section. Each team has an agent from the FBI and HHS-Office of the Inspector General.