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Medicare Fraud Strike Force Expands Operations

John Commins, for HealthLeaders Media, December 16, 2009

With nearly 500 arrests in four cities, and more than $1 billion in fraudulent claims identified in less than two years, federal officials have announced that the highly successful Medicare Fraud Strike Force will expand to Brooklyn, Tampa, and Baton Rouge.

Tuesday's announcement came on the same day that prosecutors in Miami, Detroit, and Brooklyn unsealed criminal indictments against 30 people—including doctors and nurses—who were charged with alleged schemes to bilk Medicare out of $61 million in false claims.

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

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators, who rely on Medicare data analysis and community policing. The expansion of strike force operations into seven cities is a key component of the so-called Health Care Fraud Prevention & Enforcement Action Team, a joint initiative announced in May between DOJ and HHS.

"In Miami, Los Angeles, Detroit, and Houston, the Medicare Fraud Strike Force is making significant progress against these schemes," Breuer said. "Through the strike force's proven data analysis, we are now also identifying the worst offenders in Brooklyn, Tampa, and Baton Rouge, and we will continue to target Medicare fraudsters in these communities."

Charges against the defendants arrested this week include conspiracy to defraud Medicare, conspiracy to launder money, money laundering, criminal false claims, making false statements, and receiving kickbacks. The defendants allegedly participated in schemes to submit claims to Medicare for products and services that were medically unnecessary and often never provided.

In Detroit, defendants allegedly paid kickbacks to patients who received instructions from sham clinic owners and recruiters to feign symptoms to justify expensive testing, including nerve conduction studies. In Brooklyn, two defendants allegedly billed Medicare for durable medical equipment for beneficiaries who often did not need them. In Miami, 15 defendants, including doctors and nurses, allegedly made fraudulent claims to Medicare for home health services. In a separate Miami case, defendants allegedly submitted false claims from a storefront HIV/AIDS clinic for sham injection and infusion treatments.

Collectively, the defendants in the three cities allegedly submitted about $61 million in false claims to Medicare. Since the strike force's inception in March 2007, more than 460 people have been indicted from sham operations that collectively have falsely billed Medicare for more than $1 billion.


John Commins is a senior editor with HealthLeaders Media.

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