By Jennifer J. Thomas

The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS) announced on June 18, 2015, that the efforts of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the DOJ and HHS to prevent and deter Medicare fraud, resulted in a nationwide Medicare Fraud Strike Force take down with charges against 243 individuals in 17 districts involving $712 million in Medicare fraud claims. In New Orleans alone, eleven individuals were charged in five separate schemes totaling almost $110 million in allegedly fraudulent claim submissions to Medicare.   Grand juries in the Eastern District of Louisiana returned four indictments charging defendants with crimes involving 13 companies in addition to a criminal complaint filed against another defendant. The schemes involved home health care services, psychological testing services, durable medical equipment, and psychotherapy services. The Medicare claims were allegedly submitted between 2007 through 2015 for services and equipment that were either not medically necessary or not provided at all.

HEAT claims that as a result of the Medicare Fraud Strike Force teams work since 2007 more than 2,300 defendants have been charged with defrauding Medicare of more than $7 billion and convictions of approximately 1,800 defendants of felony health care fraud offenses.   The June 18th takedown made history with the most defendants charged and the largest alleged loss amount. It also demonstrates the movement of the Medicare Fraud Strike Force to districts outside of the current nine Medicare Fraud Strike Force locations: Baton Rouge, Louisiana; Brooklyn, New York; Chicago, Illinois; Dallas, Texas; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami-Dade, Florida; and Tampa Bay, Florida. The expansion of Medicare fraud prevention efforts is attributed to funding provided by the Affordable Care Act, which provides $350 million over ten years for tools such as: advanced predictive modeling technology; enhanced screening for providers who may pose a higher risk of fraud or abuse; and tougher federal sentencing guidelines for health care fraud. Given the success of HEAT and the Medicare Fraud Strike Force teams, it is expected that the government will continue to hotly pursue those individuals engaging in Medicare fraud. For health care providers wanting to stay out of the HEAT, regular Medicare compliance reviews of business and billing practices is the key for staying cool.

The press releases from the U.S. Department of Justice and the U.S. Eastern District of Louisiana detailing the June 18th takedown as well as other enforcement actions can be viewed at http://www.justice.gov/.