Archive for the ‘Health Care Fraud’ Category
Hospice – Homecare – Preventing Medical Identity Theft
How to Prevent Homecare and Hospice Medical Identity Theft
As more and more baby boomers reach their golden years, more and more of them need the services of homecare and hospice agencies. This rapid influx is good for the industry, but agencies need to be as vigilant as ever in their hiring practices of caregivers.
Why? Because medical identity theft is on the rise, and homecare and hospice agencies are easy targets. You need to take immediate action to safeguard your agency, reputation, and clients from the growing threat of medical identity theft.
Medical identity theft is an insidious crime in which an identity thief uses someone else’s identity to gain access to medical services, treatment, or equipment. Since elderly patients are particularly vulnerable to the dangers of medical identity theft, your agency must take extra precautions. This includes stringent hiring protocols and foolproof IT policies and procedures.
Most agencies consult with experts to ensure their entire operation is protected from medical identity theft. Through a comprehensive review of the organization, medical identity theft experts ensure that homecare and hospice agencies:
• Perform thorough background checks on all employees: Employees are the first line of defense to prevent medical identity theft, so it’s critical that homecare and hospice agencies put employees through a rigorous screening process. A medical identity theft expert assists with criminal background checks, speaking with references, and setting up a system for maintaining extensive employee records.
• Create medical identity theft policies and procedures: Professional agencies need to have a strict set of policies and procedures in place to safeguard protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).
• Ensure patient records are secure: Agencies should also have a secure IT network that only allows authorized users to access sensitive patient information. A medical identity thief can run rampant and ruin lives with the push of a button unless safeguards are built into the system. Complex passwords should be implemented only for those employees who need access to patient records.
• Make sure both the doctors and patients are “real”: Many medical identity thieves prey on the system by actually impersonating doctors and patients for monetary gain. This includes pretending to be a doctor to prescribe medication for the thief and/or his cohorts, as well as using another person’s insurance card to obtain medical services. Do your homework to ensure that physicians have professional references and admitting privileges to medical facilities.
As a homecare or hospice agency, you can significantly reduce your vulnerability to medical identity theft by working with a medical ID theft expert. Visit www.TheIdentityAdvocate.com or call 310.831.4400 to schedule your comprehensive medical identify theft review. And, don’t forget to ask how you can safeguard your agency with an eye-opening “Lunch and Learn” for your employees.
Data Breaches and Electronic Health Records more source for Identity Theft
Read this great article posted at Fierce EMR ( http://www.fierceemr.com/story/ehrs-major-cause-patient-info-breaches/2012-04-12?utm_medium=nl&utm_source=internal ) and continue to worry about who has access to your person health information. Identity Theft is coming at everyone from so many sources, whether it is from a stolen laptop, thumb-drive, Identity Theft rings or cyber-hacking, we can never be sure who can access our information. And what do you do to protect it or more importantly who quickly can you recover your information if it has been compromised? See my website protection page information at: http://www.theidentityadvocate.com/identity-theft-protection.php.
Call or connect with me for questions!
DOJ Press Release: Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
U.S. Department of Justice February 14, 2012
Office of Public Affairs (202) 514-2007/TDD (202)514-1888
WASHINGTON—Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in fiscal year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.
These findings, released today in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste, and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.
“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what’s been achieved in the last fiscal year by the department’s prosecutors, analysts and investigators—and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”
“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”
Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.
The recently enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts, and greater oversight of private insurance abuses.
Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.
In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.
Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes. This is the highest number of health care fraud defendants charged in a single year in the department’s history. Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.
In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.
The departments also continued their successes in civil health care fraud enforcement during FY 2011. Approximately $2.4 billion was recovered through civil health care fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.
The fraud prevention and enforcement report announced today coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements today are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.
The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.
Medical Identity Theft on ABC News Good Morning America
This is a great clip about Medical Identity Theft and real people talking about their real case!
Remember, protect your valuable information, consider Entrust America when reviewing option of protection; the only product The Identity Advocate endorses. Entrust America
Medicare Fraud of $5.5 Million in False Claims billed for Unlicensed Massage Therapists billing as Physical Therapy FBI Press release
Owner of Doraville Medical Clinic Indicted for Health Care Fraud
Atlanta Hope Medical Group Billed Medicare for Doctor Services Never Performed
U.S. Attorney’s Office January 18, 2012
Northern District of Georgia (404) 581-6000
ATLANTA—DAVID SONG SEN CUI, 43, of Duluth, Georgia, has been indicted by a federal grand jury on charges of health care fraud.
United States Attorney Sally Quillian Yates said of the case, “Medicare dollars provide critical medical services for elderly and disabled persons. This defendant is charged with defrauding Medicare by repeatedly billing for ‘physical therapy’ that in truth was only massages given by unlicensed massage therapists. Medicare and our taxpayers cannot afford such criminal abuse of health care dollars.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “The FBI, in conjunction with its various law enforcement partners, is committed to the protection of such federally funded programs. Individuals engaged in such fraudulent acts, as is alleged in this indictment, demonstrate a lack of compassion and greed that simply cannot and will not be tolerated. The FBI urges anyone with information regarding healthcare fraud activity to contact its nearest FBI field office.”
According to United States Attorney Yates, the charges, and other information presented in court: From November 2008 through August 2011, CUI operated the Atlanta Hope Medical Group, Inc., a clinic located in Doraville, Georgia. The clinic purported to provide physical therapy services for elderly patients. However, the clinic actually offered massage services, which were performed by unlicensed massage therapists. CUI allegedly billed the massages fraudulently to Medicare as “physical therapy” under a doctor’s name who did not render the services and was not even present at the clinic. As part of the scheme, Atlanta Hope employed a doctor who was present at the clinic only two days a week. The indictment alleges that, during the operation of the clinic, CUI fraudulently billed over $5.5 million in false claims to Medicare.
The indictment charges 11 counts of health care fraud. Each count carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.
Members of the public are reminded that the indictment contains only allegations. A defendant is presumed innocent of the charges and it will be the government’s burden to prove a defendant’s guilt beyond a reasonable doubt at trial.
This case is being investigated by special agents of the Federal Bureau of Investigation.
Assistant United States Attorney Shanya J. Dingle is prosecuting the case.
For further information, please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.
Arrests made in Unapproved Stem Cell Treatments
FBI Press Release
This is not only scary but potential lethal. Having an incurable disease, seeing these people with great hope, more health care spend…what a dishonor.
Federal Indictments Lead to Arrests in Stem Cell Case
U.S. Attorney’s Office December 28, 2011
Southern District of Texas (713) 567-9000
Three men have been arrested for their participation in a scheme to manufacture, distribute and sell to the public stem cells and stem cell procedures that were not approved by the Food and Drug Administration (FDA), United States Attorney Kenneth Magidson announced today along with Assistant Attorney General Tony West of the Department of Justice’s Civil Division, Special Agent in Charge Patrick J. Holland of the FDA-Office of Criminal Investigations (OCI) and Special Agent in Charge Cory B. Nelson of the FBI.
Francisco Morales, 52, of Brownsville, Texas, was arrested by Customs and Border Protection agents pursuant to a arrest warrant late Dec. 22, 2011. He made his initial appearance the following morning at which time he was ordered held without bond. Alberto Ramon, 48, of Del Rio, Texas, and Vincent Dammai, 40, of Mount Pleasant, S.C., were arrested yesterday. Ramon was arrested as he was about to enter his clinic and has already made his initial appearance in Del Rio, while Dammai was arrested in Florence, S.C., and is expected to make his initial appearance in Charleston, S.C., this morning. Lawrence Stowe, 58, of Dallas, Texas, also charged in relation to this case, is considered a fugitive and a warrant remains outstanding for his arrest. The two indictments in this matter, returned Nov. 9 and 10, 2011, have been unsealed by order of the court.
“Protecting the public from unproven and potentially dangerous drug and medical procedures is very important,” said Magidson. “This office will continue to prosecute violations involving threats to the public health.”
“This investigation identified a scheme whereby the suffering and hopes of victims in extreme medical need were used and manipulated for personal profit,” said Nelson. “The predatory and opportunistic nature of the crimes alleged in this indictment mirrors images from science fiction.”
The defendants allegedly conspired to commit mail fraud and unlawfully distributed stem cells derived from umbilical cord blood. According to the indictment, Morales and the others manufactured, distributed and used stems cells produced from umbilical cord blood to perform procedures not approved by the FDA to treat persons suffering from cancer, amytrophic lateral sclerosis (ALS), multiple sclerosis (MS) and other autoimmune diseases. FDA approval is required before stem cells can be marketed to the public and used to treat incurable diseases and the FDA has not determined that stem cells are safe and effective in treating these diseases.
“This indictment demonstrates the commitment of the FDA to protect the American public from the harms inherent in being exposed to unapproved new drugs,” said Holland. “The FDA will continue to aggressively pursue perpetrators of such acts and ensure that they are punished to the full extent of the law.”
Beginning in March 2007 and continuing through 2010, the indictment alleges Morales falsely represented to the public that he was a physician licensed to practice medicine in the United States and provided medical advice to individuals regarding the benefits of stem cell treatments. Morales also allegedly falsely represented that he operated a medical clinic named Rio Valley Medical Clinic in Brownsville, Texas, in order to convince the public that he specialized in using stem cells to treat incurable diseases. After meeting patients in the United States, Morales would allegedly travel to Mexico to perform the stem cell procedures. The indictment further alleges that Stowe marketed, promoted and sold stem cells along with other drug and biological products for the treatment of cancer, ALS, MS and Parkinson’s Disease that had not been reviewed or approved by the FDA. Stowe operated several entities, including The Stowe Foundation and Stowe Biotherapy Inc., through which he allegedly marketed and sold these products.
The stem cells referenced in the indictment were created and manufactured from umbilical cord blood obtained from birth mothers who were patients of Ramon—a licensed midwife who operated The Maternity Care Clinic in Del Rio, Texas. Ramon allegedly sold the cord blood to a company called Global Laboratories located in Scottsdale, Ariz. After obtaining the cord blood from Ramon, the indictment alleges Global Laboratories would send the tissue to Dammai—a professor of pathology and laboratory medicine in Charleston, S.C. Dammai, without obtaining approval from FDA or University authorities, allegedly used university facilities to create stem cells that were later sold by Global Laboratories. As a result of this fraudulent scheme, the public was mislead into believing that stem cells and other drug and biological products sold by defendants had been approved by the FDA to treat cancer, ALS, MS and Parkinson’s Disease, The defendants allegedly received more than $1.5 million from patients suffering from incurable diseases.
The case is being prosecuted by Assistant United States Attorneys Samuel Louis and Cedric Joubert with the assistance of Carol Wallack with the Consumer Protection Branch in the Department of Justice’s Civil Division. The case was investigated by the FDA-OCI, FBI and Internal Revenue Service-Criminal Investigations.
An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.
FBI Press Release – Medtronic to pay $23.5 million
Minnesota-Based Medtronic Inc. Pays U.S. $23.5 Million to Settle Claims That Company Paid Kickbacks to Physicians
U.S. Department of Justice December 12, 2011
Office of Public Affairs (202) 514-2007/TDD (202) 514-1888
WASHINGTON—Medtronic Inc. of Fridley, Minn., has agreed to pay the United States $23.5 million to resolve allegations that it violated the False Claim Act by using physician payments related to post-market studies and device registries as kickbacks to induce doctors to implant the company’s pacemakers and defibrillators, the Justice Department announced today.
Post-market studies are intended to assess the clinical performance of a medical device or drug after that device or drug has been approved by the Food and Drug Administration. Registries are collections of data maintained by a device manufacturer concerning its products that have been sold and implanted in patients.
The United States contends that Medtronic caused false claims to be submitted to Medicare and Medicaid by using two post-market studies and two device registries as vehicles to pay participating physicians illegal kickbacks to induce them to implant Medtronic pacemakers and defibrillators. Although Medtronic collected data and information from participating physicians, each of the studies and registries required a new or previous implant of a Medtronic device in each patient, and in each case Medtronic paid participating physicians a fee ranging from approximately $1,000 to $2,000 per patient. The United States contends that Medtronic solicited physicians for the studies and registries in order to convert their business from a competitor’s product and/or persuade the physicians to continue using Medtronic products.
“Patients who rely on their healthcare providers to implant vital medical devices expect that those decisions will be made with the patients’ best interests in mind,” said Tony West, Assistant Attorney General for the Civil Division. “Kickbacks, like those alleged here, distort sound medical judgments with financial incentives paid for by the taxpayers.”
“Medicare and Medicaid beneficiaries depend on their physicians to make decisions based on sound medical judgment, especially when they are choosing which pacemaker or defibrillator to implant,” said B. Todd Jones, U.S. Attorney for the District of Minnesota. “Medical device manufacturers must not be permitted to use improper payments to cloud that judgment.”
“Today’s settlement highlights one of the key purposes of the Anti-Kickback law—to ensure that the judgment exercised by health care providers in treating Medicare and Medicaid patients is not influenced by unlawful payments,” said Benjamin Wagner, U.S. Attorney for Eastern District of California.
“Patients trust that decisions to implant certain pacemakers or other medical devices are based on their own health interests and not influenced by kickbacks,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Companies distorting medical decision-making through kickbacks can expect that OIG investigators and our law enforcement partners will actively investigate and prosecute such unlawful conduct.”
The settlement resolves allegations contained in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act that are pending in Minnesota and California, respectively. As part of today’s resolution, the whistleblowers will receive payments totaling more than $3.96 million from the federal share of the recovery.
This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover nearly $6.5 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are more than $8.5 billion.
This settlement was the result of an investigation by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the District of Minnesota, the U.S. Attorney’s Office for the Eastern District of California, the Office of Inspector General at the U.S. Department of Health and Human Services, and the FBI.
OIG HHS updated most wanted list for Healthcare Fraud
Click here to see and review the top 10 most wanted fugitives for Health Care Fraud
Preventing Medical Identity Theft – Palm Scanning
See the quick video about Palm Scans at El Centro Hospital:
Palm Scanning started at facilities back east. Good to see its arrival here in California. This procedure can assist in the prevention of Medical Identity Theft and Identity Fraud!
Department of Justice News and Strike Force Update Charges 94 doctors for $251 Million in Alleged False Billing
Department of Justice
Office of Public Affairs Press Release
WASHINGTON – Ninety-four people have been charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program in the continuing operation of the Medicare Fraud Strike Force in Miami; Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston, announced Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI Director Robert Mueller and Daniel R. Levinson, Inspector General of HHS. The operation announced today is the largest federal health care fraud takedown since Medicare Fraud Strike Force operations began in 2007.
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. More than 360 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in today’s operation.
“Our continued Strike Force operations reflect the unprecedented commitment that inspired the creation of the Health Care Fraud Prevention and Enforcement Action Team in May 2009,” said Attorney General Holder. “With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet. The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”
“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Secretary Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”
Charges were unsealed today against 94 individuals who are accused of various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home health care schemes, HIV infusion fraud schemes and durable medical equipment (DME) schemes. Thirty-six defendants charged in these schemes have been arrested in Miami, New York, Baton Rouge and Detroit and additional arrests are expected throughout the day.
According to the court documents, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, indictments and complaints allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the treatments that, in reality, were unnecessary or never provided. Collectively, the doctors, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit more than $251 million in false claims to the Medicare program.
In Miami, 24 defendants were charged for allegedly participating in various fraud schemes that led to approximately $103 million in false billings. According to court documents, the fraud schemes involved fraudulent billing for HIV infusion services, home health care and physical therapy services, DME and pharmaceutical medications. The defendants include owners and operators of companies, doctors, nurses, and patient recruiters, as well as a medical biller who is alleged to have billed approximately $49 million for fraudulent services.
Thirty-one defendants were charged in Baton Rouge for various schemes allegedly involving fraudulent claims for DME totaling approximately $32 million. The defendants include the owners and operators of nine different purported medical services companies and four doctors, 14 patient recruiters and other individuals who allegedly worked at the medical services companies.
Twenty-two defendants were charged in Brooklyn for their alleged participation in schemes to submit fraudulent claims totaling approximately $78 million. These fraud schemes involved false billing for physical and occupational therapy and DME. The defendants include the owners and operators, patient recruiters and employees at three different purported medical clinics and a medical equipment company, as well as three doctors. According to court documents, six of the defendants charged are serial Medicare beneficiaries, who purported to seek medical treatment from numerous providers, causing the submission of multiple claims to Medicare for purported medical treatments.
In Detroit, 11 defendants were charged for their alleged roles in schemes to submit fraudulent claims to Medicare for home health services, nerve conduction tests and injection and infusion therapy sessions. The schemes involved a total alleged fraud of approximately $35 million and five different purported medical services companies.
Four defendants were also charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for DME.
In addition to making arrests around the country, law enforcement agents are executing search warrants in connection with ongoing health care fraud investigations.
“Today’s charges allege attempts by individuals to defraud the Medicare program of $251 million,” said FBI Director Robert S. Mueller, III. “Countless Americans rely on Medicare for their well-being, and the FBI, working in conjunction with our federal agency partners, is resolute in its commitment to stop those who would illegally manipulate the system.”
“Today’s arrests illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities,” said Daniel R. Levinson, Inspector General of HHS. “To combat this fraud, the government’s response must also be swift, agile, and organized – a HEAT initiative goal which is well illustrated by today’s Strike Force actions.”
The Strike Force operations in Miami, Baton Rouge, Brooklyn, Detroit and Houston are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The HEAT task force, co-chaired by Acting Deputy Attorney General Gary G. Grindler and Deputy Secretary Bill Corr, 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 Holder and Secretary 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. In December 2009, Strike Force operations were expanded to Brooklyn, Baton Rouge and Tampa.
Since its inception in March 2007 with Phase One in South Florida and continuing through its most recent expansion into Tampa, Fla., the Strike Force has obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
The cases announced today are being prosecuted and investigated by Strike Force teams comprised of attorneys from the Fraud Section in the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the Southern District of Florida, the Eastern District of New York, the Middle District of Louisiana, the Eastern District of Michigan and the Southern District of Texas; and agents from the FBI and HHS-OIG.
The Railroad Retirement Board Office of Inspector General and the Office of Personnel Management-Office of Inspector General also participated in today’s operation.
An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.
To learn more about the HEAT team, go to: www.stopmedicarefraud.gov.
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