DOJ expands strike forces to target Medicare fraud

The federal government is multiplying by 10 the number of agents and prosecutors targeting Medicare fraud in Miami, Los Angeles and other strategic cities where officials say tens of billions of dollars are lost each year.

"We know these strike forces work," Attorney General Eric Holder said at a news conference in Washington on Wednesday.

Smaller scale operations have netted 146 convictions and recovered $186 million in Miami since 2007. But they will have more muscle and money than they did under the Bush administration, with manpower from the Department of Justice and the Department of Health and Human Services and a 50 percent increase of $311 million in their 2010 budget.

In Miami, officials estimate Medicare fraud costs the system more than $3 billion a year.

But when the Justice Department started a strike force there in 2007, it was working with just a handful of prosecutors. Federal and local officials also squabbled over whether to prosecute patients, along with the providers, who were participating in elaborate fraud schemes.

The fraud there is so rampant in some neighborhoods that it's become a cultural norm, with some patients raking in more than $1,000 a month, said Kirk Ogrosky, deputy chief of the U.S. Justice Department's criminal fraud section.

But with a new Health Care Fraud Prevention and Enforcement Action Team, dubbed the HEAT task force, hundreds of agents and prosecutors will establish an increased presence in Miami and Los Angeles. The initiative will also target Houston and Detroit, where agents say Miami fraudsters are migrating and launching similar scams involving HIV/infusion drugs and physical therapy.

Strike forces will also be established in about 10 other major cities, though they were not named.

Officials say the comprehensive national approach will give law enforcement the brawn it needs to break through some of the nation's most fraud-prone neighborhoods.

Miami has long been the center of U.S. health care fraud, with providers and patients fueling the cycle. In some neighborhoods, patients are recruited by brokers who go door-to-door, offering hundreds of dollars for use of their Medicare numbers. They often target new citizens and immigrants, sometimes entire families. Many barely speak English.

In one case, a supplier billed the government $2 million for a single wheelchair by sending repeated bills, each one on behalf of a different beneficiary.

Another company billed Medicare enough to allow the owner to buy a Rolls-Royce. When inspectors visited the office, they found it was little more than a broom closet.

The fraud moves so swiftly that officials have struggled to catch up. Officials say that by the time they are alerted to a suspicious company, the business has already shut down and likely set up camp somewhere else under a different name.

But the new partnership will allow better sharing of real-time intelligence data on health care fraud patterns. Agents can closely monitor claims payment data, spot suspicious billing patterns immediately and conduct surveillance on targeted providers, Holder said.

This will "not only allow us to stop fraudulent schemes and practices quickly before they take root, but it also will allow us to identify and expose systemic vulnerabilities that have been abused by traditional health care providers," he said.

HEAT will also work with state Medicaid officials to audit providers and more closely monitor their activities.

The Justice Department is also working to establish additional enforcement teams to prosecute fraud in the Medicare Part D program and the Medicaid/Children's Health Insurance programs.

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On the Net:http://www.hhs.gov/stopmedicarefraud