WASHINGTON — "Medicare fraud schemes are driven by greed—pure and simple," said Assistant Attorney General Lanny A. Breuer of the U. S. Department of Justice Criminal Division. At a press conference yesterday, Breuer and HHS Secretary Kathleen Sebelius announced the Medicare Fraud Strike Force had expanded its efforts to combat fraudsters in Brooklyn, N.Y.; Tampa, Fla.; and Baton Rouge, La., using data analysis to identify "the worst offenders" in those areas.
The Strike Force began operations in Miami in March 2007 and subsequently added Los Angeles, Detroit and Houston to its roster.
The recent three-city expansion is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint DOJ-HHS initiative announced in May. The HEAT taskforce includes law enforcement agents, prosecutors and staff from both departments and their operating divisions. 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, and each team has an agent from the FBI and HHS-OIG.
Since its inception, the Strike Force has obtained indictments of more than 460 individuals and organizations that have falsely billed the Medicare program for more than $1 billion, according to HHS.
"Rather than waiting for people to come forward and tell us that fraud is happening, we're coming to the fraud and stopping it before it happens," Breuer said of the Strike Force model. Once data analysis points up a potential area of abuse, cases then are pursued with traditional law enforcement techniques.
Breuer also announced the indictments of 32 individuals in Miami, Detroit and Brooklyn. Collectively, the physicians, business owners, executives and others charged in the indictments are accused of conspiring to submit $61 million in false claims.
"In Detroit, we allege that the defendants fraudulently billed Medicare for physical and occupational therapy as well as diagnostic testing. In Miami, it is fraudulent HIV infusion clinics and the most recent trend—fraudulent billing related to home health care. And here in New York, where we are just getting started, we've already seen fraud schemes involving durable medical equipment and diagnostic testing," Breuer said.
The New York (Brooklyn) case involves two defendants alleged to have billed Medicare for shoe inserts for diabetes when, in fact, cheaper over-the-counter shoe inserts were provided to beneficiaries who often did not need them, prosecutors said.
At the press conference, Benton J. Campbell, U.S. attorney for the Eastern District of New York, showed a pair of $10 OTC inserts he said the defendants provided to patients while billing for more expensive diabetes inserts that cost up to $180.
