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From Health Law Daily, June 19, 2015

Medicare Fraud Strike Force sets record with $712 million takedown

By Bryant Storm, J.D.

The Medicare Fraud Strike Force led a nationwide fraud takedown in 17 districts, involving charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes that led to nearly $712 million in false Medicare billing. CMS also suspended the Medicare privileges of multiple providers as a result of the takedown. According to the announcement from HHS Secretary Sylvia Burwell and Attorney General Loretta Lynch, the takedown is the largest in Strike Force history in terms of defendants charged and the amount of loss.

Fraud. The charges resulted from a number of fraud schemes related to home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and pharmacy fraud. Charges included conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. Nearly 50 of the defendants charged were arrested and charged for fraud related to Medicare Part D, the Medicare prescription drug benefit program.

Kickbacks. Attorney General Lynch described some of the actions taken by the defendants by saying “they billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.” Additionally, the release specifies that, in many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for information that was used to then submit fraudulent bills to Medicare for unnecessary or never-performed services. The national takedown effort included individual takedowns in Miami, Houston, Dallas, Los Angeles, Detroit, Tampa, Brooklyn, N.Y., and New Orleans.

ACA. The HHS announcement credited the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) with providing new tools and resources to help fight fraud and effectuate takedowns. Specifically, the law provides $350 million in additional funding for health care fraud prevention and enforcement efforts. The additional funding was instrumental in allowing the Department of Justice to hire additional prosecutors and enabling the Strike Force to expand its reach from just two cities to nine. Tougher sentencing, provider screening, and increased data sharing under the ACA have also contributed to the effort to combat health care fraud.

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