A cooperative effort between federal agencies and state and local enforcement personnel has netted about 40 arrests in south Florida, as a recently launched Medicare "strike force" begins to target fraudulent billing that costs the program billions of dollars a year.
The strike force's initial efforts focused on infusion therapy and durable medical equipment providers in the Southern District of Florida. Some 38 people were arrested on Tuesday.
The investigation, in place since March 1, said the individuals and the companies they work for filed claims of more than $142 million with Medicare. Charges brought against those arrested included conspiracy to defraud the Medicare program, criminal false claims and violations of anti-kickback statutes.
Defendants could face jail sentences of as much as 20 years on the charges, the federal agencies announced.
At the federal level, investigators from the Department of Justice and Department of Health and Human Services are cooperating through the recently formed strike force.
That cooperation is being augmented by the ability to conduct real-time analysis of billing data from Medicare Program Safeguard Contractors and claims data from HHS' Health Care Information System, said Bryan Sierra, a spokesman for the Department of Justice.
While this initial effort was focused on south Florida, the strike force expects to pursue investigations in other geographic areas of the country and will be using claims data to detect other types of Medicare fraud, Sierra said.
Infusion therapy and durable medical equipment have been identified by the Centers for Medicare & Medicaid Services as initial areas for investigation. CMS says the strike force is one of many initiatives it's implementing to increase accountability and eliminate fraudulent providers.
"The Medicare Fraud Strike Force is just one weapon in our arsenal to protect Medicare beneficiaries and taxpayers from fraud," said HHS Secretary Michael Leavitt. "I will be working closely with the Administration and Congress to put processes in place that will improve the industry and eliminate the likelihood for deception," Secretary Leavitt said. "We will be announcing the second step in this multi-year process within the next month."
"History has shown that healthcare fraud is best investigated jointly. The FBI, as part of the Medicare Fraud Strike Force, worked closely with its law enforcement partners and oversight authorities to assist investigations of fraud, waste and abuse across Southern Florida," said Kenneth W. Kaiser, assistant director of the FBI criminal investigative division.
Florida has become an area where a lot of fraud is occurring, and CMS is increasing its attention there, CMS officials said.
"CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions," said Leslie Norwalk, acting administrator of CMS. "We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain."