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Latest Medicare Fraud Strike Force Takedown Is The Most Significant To Date

As we discussed yesterday, the Medicare Fraud Strike Force’s eighth annual nationwide takedown resulted in charges in 17 districts against 243 individuals for approximately $712 million in false billings.

It is the most significant of the Strike Force’s nationwide takedowns to date.  By way of comparison, as we noted in our January 2015 year-in review, in 2013, the Strike Force brought charges in eight districts against 89 individuals for approximately $223 million in false billings, and in 2014, the Strike Force brought charges in six districts against 90 individuals for approximately $260 million in false billings.  The number of individuals charged and the total amount of false billings alleged this year has nearly tripled.  Indeed, the takedown this year in the Southern District of Florida (Miami) alone involved charges against 73 individuals for approximately $263 million in false billings -- results on par with the entirety of each of the 2013 and 2014 takedowns.  Additionally, 46 of the individuals just charged were doctors, nurses or other licensed medical professionals, as compared to 27 last year.   Moreover, the Strike Force’s efforts have expanded beyond  the districts that are part of the Strike Force to the District of Alaska, the Southern District of California, the District of Connecticut, the Southern District of Georgia, the Western District of Kentucky, the District of Maryland, and the Northern District of Ohio.

What is responsible for the vastly increased scope of this year’s takedown?  It certainly is not due solely to reporting the results of 13 rather than 12 months of law enforcement and regulatory efforts.  It may be due generally speaking to having the new U.S. Attorney General, Loretta E. Lynch, officially in place for six weeks now and having the current Assistant Attorney General in charge of DOJ’s Criminal Division, Leslie R. Caldwell, on the job for a year.

More specifically though, it may be due to specific efforts that AAG Caldwell noted in speaking about the latest takedown:

Every day, the Criminal Division is more strategic in our approach to prosecuting Medicare Fraud,” said Assistant Attorney General Caldwell. “We obtain and analyze billing data in real-time. We target hot spots – areas of the country and the types of health care services where the billing data shows the potential for a high volume of fraud – and we are speeding up our investigations. By doing this, we are increasingly able to stop schemes at the developmental stage, and to prevent them from spreading to other parts of the country.

There are other strategies that AAG Caldwell noted in a speech last September, perhaps most importantly the new procedure that qui tam complaints would be shared by the Civil Division with the Criminal Division as soon as cases are filed.  Whether that was at play here is not yet clear, but we should expect it given the invigorated efforts of DOJ and its partners not to mention the financial benefit.

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Bridget Rohde