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Medicare Fraud Strike Force Bust Involves Highest Amount of False Billings in a Single Takedown

2012 is already a record-breaking year in health care fraud enforcement.  This week Attorney General Eric Holder and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius announced the biggest takedown in the history of the Medicare Fraud Strike Force (Strike Force) in terms of Medicare dollars at stake.  The Strike Force executed this takedown in seven cities across the country, including Tampa, Houston, Baton Rouge and Los Angeles.  Charges were filed against 107 individuals for schemes involving $452 million in false Medicare billing, and 59 of those individuals were in South Florida and were responsible for $137 million of the fraudulent billing alleged.

The types of providers targeted in the takedown ranged widely, as did the industries in which they practiced.  In addition, the defendants were accused of various crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering.   Notably, many of the individuals charged provided services in industries that have received considerable government attention in recent years, including home health care and durable medical equipment (DME).  The defendants were also charged under statutes used by the government with increasing frequency in its prosecution of health care fraud.  (For more information about these particular trends, read the articles published by Mintz Levin’s Health Care Enforcement Defense Group on trends in health care fraud enforcement in 2011.)

In addition to the 107 individuals charged as a result of the Strike Force’s takedown, HHS reported that it suspended or took other administrative action against 52 health care providers following a data-driven analysis and credible allegations of fraud.  In her comments about the takedown and provider suspensions, Secretary Sebelius shed some light on the government’s new potential enforcement focus for 2012 and beyond.  She noted, “[t]oday’s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious… In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made.  Today’s actions are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program.”

More specific information about the individuals charged and the conduct at issue can be found on the websites of the Office of Inspector General for HHS and the U.S. Attorney’s Office for the Southern District of Florida.  However, the general message of the government’s efforts seems clear: the government is steadfast in its aggressive pursuit of health care fraud and eager to use massive takedowns to send a message to would-be fraudsters about the breadth of the its enforcement resources.

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Author

Samantha P. Kingsbury is a Mintz attorney who focuses on health care enforcement defense matters, representing clients in criminal and administrative actions. She also assists clients with internal investigations, and she has experience preparing self-disclosures and other enforcement reports.