Strike force sweeps up ram­pant Medi­care fraud

The Washington Times Weekly - - Politics - BY JERRY SEPER AND CHUCK NEUBAUER

Start­ing in the spring of 2007, fed­eral, state and lo­cal law en­force­ment of­fi­cials came to­gether in South Florida to hunt down and charge peo­ple with de­fraud­ing the coun­try’s multi­bil­lion-dol­lar Medi­care sys­tem.

Known as the Medi­care Fraud Strike Force and now ex­panded across the coun­try, the group has since in­dicted more than 300 health care providers na­tion­wide and has bro­ken up op­er­a­tions that ac­counted for more than $700 mil­lion in fraud­u­lent Medi­care claims.

For­mer U.S. At­tor­ney R. Alexan­der Acosta, who put a pri­or­ity on health care fraud cases when he was the gov­ern­ment’s chief pros­e­cu­tor in Mi­ami, said the de­ci­sion in Wash­ing­ton to make such co­or­di­nated ef­forts per­ma­nent is start­ing to have an im­pact, but that more needs to be done to make a real dent in the kick­back and false-billing schemes that plague the na­tional health care pro­gram.

“The fight against health care fraud had al­ready be­gun at the lo­cal level, but the strike forces brought ad­di­tional man­power, ex­per­tise and nec­es­sary re­sources,” said Mr. Acosta, now dean of the Florida In­ter­na­tional Uni­ver­sity Col­lege of Law in Mi­ami.

“They put a spot­light on a na­tional prob­lem, al­lowed us to con­tinue our work and more than dou­bled the re­sources avail­able to us,” he said. “It has be­come a very suc­cess­ful part­ner­ship for a too-of­ten-ig­nored prob­lem.”

As­sis­tant At­tor­ney Gen­eral Lanny A. Breuer, who heads the Jus­tice Depart­ment’s crim­i­nal divi­sion, told the Se­nate in May that fed­eral and state spending on Medi­care and Med­i­caid to­taled $800 bil­lion a year and that “ac­cord­ing to var­i­ous es­ti­mates, some­where be­tween 3 and 10 per­cent of this spending is lost to waste, fraud and abuse.”

Mr. Breuer told The Wash­ing­ton Times that be­cause crim­i­nals are “de­vis­ing more so­phis­ti­cated ways of steal­ing bil­lions of dol­lars from fed­er­ally ad­min­is­tered health care pro­grams, and they are steal­ing it faster now than ever be­fore,” the Jus­tice Depart­ment is com­mit­ted to shut­ting them down.

“We must stop the bleed­ing, and we are com­mit­ted to do so,” he said.

Medi­care is a gov­ern­ment­paid in­sur­ance pro­gram be­gun in 1965 that pro­vides health care to about 40 mil­lion peo­ple 65 and older and 7 mil­lion younger peo­ple with per­ma­nent dis­abil­i­ties. The pro­gram ac­counted for about 13 per­cent of the fed­eral bud­get and 19 per­cent of the to­tal health care ex­pen­di­tures in 2008.

Health and Hu­man Ser­vices Sec­re­tary Kath­leen Se­be­lius said the strike force has a “proven record of suc­cess,” us­ing a datadriven ap­proach to iden­tify un­ex­plain­able billing pat­terns and in­ves­ti­gate providers for fraud­u­lent ac­tiv­ity.

Build­ing on early strike-force suc­cesses un­der Pres­i­dent Ge­orge W. Bush in South Florida in 2007 and in Los An­ge­les in 2008, the Obama ad­min­is­tra­tion cre­ated new strike-force op­er­a­tions in Detroit and Hous­ton in March this year. Pro­gram in­tegrity Fraud-preven­tion ef­forts also have been strength­ened in Pres­i­dent Obama´s pro­posed fis­cal 2010 bud­get, which in­vests $311 mil­lion — a 50 per­cent in­crease over fis­cal 2009 — to bol­ster “pro­gram in­tegrity” ac­tiv­i­ties within the Medi­care and Med­i­caid pro­grams.

The anti-fraud ef­forts in the pres­i­dent´s bud­get could save $2.7 bil­lion over five years by im­prov­ing over­sight and stop­ping fraud in the Medi­care and Med­i­caid pro­grams, Jus­tice Depart­ment and HHS of­fi­cials have es­ti­mated. The of­fi­cials said that since the pro­gram’s in­cep­tion, the strike forces have filed more than 130 cases, charged more

than 300 peo­ple, ac­cepted 15 guilty pleas and won 21 con­vic­tions in 15 jury tri­als.

And the num­ber of cases has been mul­ti­ply­ing in re­cent months.

In July, a fed­eral grand jury in Hous­ton in­dicted 32 peo­ple on charges of sub­mit­ting more than $16 mil­lion in phony Medi­care claims. In some cases, the in­dict­ment said, ben­e­fi­cia­ries were de­ceased at the time the ser­vices were billed.

That same month, a fed­eral grand jury in Los An­ge­les con­victed the op­er­a­tors of a durable med­i­cal equip­ment com­pany that falsely billed Medi­care for $949,859 and were paid $597,750 for med­i­cally un­nec­es­sary power wheel­chairs and ac­ces­sories. The el­derly ben­e­fi­cia­ries said they were promised vi­ta­mins, di­a­betic shoes and other items they never re­ceived they had re­ceived the treat­ments.

Also in June, a Mi­ami doc­tor was sen­tenced to 97 months in prison in a $20 mil­lion Medi­care scheme in­volv­ing HIV in­fu­sion ser­vices. The doc­tor ad­mit­ted be­ing the co-owner of five Mi­ami clin­ics that pur­ported to spe­cial­ize in the treat­ment of HIV pa­tients, but he rou­tinely billed Medi­care for ser­vices that were not needed and of­ten were never de­liv­ered.

The gov­ern­ment also has tar­geted ma­jor cor­po­ra­tions in the ef­fort to bring some con­trol to Medi­care and Med­i­caid fraud.

In Septem­ber, U.S. phar­ma­ceu­ti­cal gi­ant Pfizer Inc. and a sub­sidiary, Phar­ma­cia & Upjohn Co. Inc., agreed to pay a $2.3 bil­lion set­tle­ment to re­solve crim­i­nal and civil li­a­bil­ity al­le­ga­tions that it fraud­u­lently sold drugs, many of which were based on Medi­care and Med­i­caid claims.

The set­tle­ment, which was the re­sult of an in­quiry be­gun dur­ing the Bush ad­min­is­tra­tion, was de­scribed by Jus­tice De-

In July, a fed­eral grand jury in Hous­ton in­dicted 32 peo­ple on charges of sub­mit­ting more than $16 mil­lion in phony Medi­care claims. In some cases, the in­dict­ment said, ben­e­fi­cia­ries were de­ceased at the time the ser vices were billed.

proved — pur­pose.”

“The FBI will not be de­terred from con­tin­u­ing to en­sure that phar­ma­ceu­ti­cal com­pa­nies con­duct busi­ness in a law­ful man­ner,” he said.

The task force is get­ting ex­tra help, bol­stered by the cre­ation this year of the Health Care Fraud Preven­tion & En­force­ment Action Team, a fed­eral, state and lo­cal ef­fort to pre­vent fraud and en­force anti-fraud laws na­tion­wide through data anal­y­sis tech­niques and an in­creased fo­cus on com­mu­nity polic­ing.

The cre­ation of the team means that fight­ing health care fraud has be­come a Cab­i­net-level pri­or­ity task for the De­part­ments of Jus­tice and Health and Hu­man Ser­vices. The task force is co-chaired by Deputy At­tor­ney Gen­eral David Og­den at Jus­tice and Deputy Sec­re­tary Bill Corr at HHS and is com­posed of toplevel law en­force­ment agents, pros­e­cu­tors and staff from both de­part­ments.

Mr. Breuer said the gov­ern- ment’s new co­or­di­nated ef­fort against health care fraud has al­lowed the strike force to iden­tify crim­i­nal-claim trends and track weak­nesses to stop false claims be­fore they oc­cur. But, he said, of­fi­cials also have learned that “we can­not pros­e­cute our way out of this prob­lem.”

“In­stead, we must pre­vent crim­i­nals from ac­cess­ing Medi­care, Med­i­caid and other health care pro­grams in the first place,” he said, and that ef­fort has just be­gun.


For­mer U.S. At­tor­ney R. Alexan­der Acosta says the im­ple­men­ta­tion of the Medi­care Strike Force is mak­ing a dent in the huge amount of fraud in the multi­bil­lion-dol­lar Medi­care sys­tem, but he said more needs to be done.

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