Largest Takedown in Strike Force History Alleges $900 Million in False Medicare Billing

By Kelly A. Briganti, Editorial Director, G2 Intelligence

Nearly a year to the day after another nationwide Strike Force takedown, the Department of Justice announced last week what it says is a takedown involving “the most defendants charged and largest alleged loss amount in Strike Force history.”
While not directly involving labs, the allegations in this takedown are not unfamiliar to labs: submitting claims to Medicare and Medicaid for services that weren’t medically necessary or weren’t even performed, paying kickbacks for referrals or to get beneficiary information to facilitate fraudulent claims, and allowing nonqualified individuals to perform services billed to Medicare. Most of the cases involved allegations linked to home health, mental health, physical/occupational therapy, durable medical equipment, and prescription drug-related Medicare and Medicaid claims.

Here’s a rundown on the details of this takedown:

• 301 individuals charged in civil and criminal cases (includes 61 physicians, nurses and licensed medical professionals)
• $900 million in total losses alleged
• 36 federal districts and 23 state Medicaid Fraud Control Units involved in the investigations and arrests
• Payment suspension authority exercised by Centers for Medicare & Medicaid Services against numerous providers
• Criminal charges brought include conspiracy to commit health care fraud, anti-kickback statute violations, money laundering, and aggravated identity theft.

“Taxpayers and Congress provided CMS with resources to adopt powerful monitoring systems that fight fraud, safeguard program dollars, and protect Medicare and Medicaid,” Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal, M.D. explained in a statement—echoing similar comments of fellow government agency heads who commented on the takedown. “The diligent use of innovative data analytic systems has contributed or led directly to many of the law enforcement cases presented here today. CMS is committed to its collaboration with these agencies to keep federally-funded health care programs safe and strong for all Americans.”

Just last June, a similarly significant nationwide health care fraud takedown was announced—including 243 individuals charged and $712 million in false billing. Health care attorney Gina L. Simms, of Ober Kaler, explained to G2 Compliance Advisor at that time: “I believe that the ‘takedowns’ are designed to put health care providers everywhere on notice that the federal government has the resources to aggressively investigate and pursue fraud.” See “Compliance Perspectives: Take Heed: Strike Force Takedowns Signal Aggressive, Coordinated Fraud Enforcement,” G2 Compliance Advisor, September 2015, p. 5.   

For tips on how labs can avoid becoming the target of these nationwide takedowns and how targeted labs should respond to such investigations, view G2 Intelligence Training on Demand recording, “Don’t Let Your Lab Become a “Take Down” Target for U.S. Law Enforcement Agencies!” featuring Gina L. Simms and Robert E. Mazer, health care attorneys with Ober Kaler. For more information, visit the Webinars and Training on Demand tab at www.g2intelligence.com or contact customer service at 1-888-729-2315.