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Medicare Fraud Crackdown in Louisiana


  • Published: 2009-10-08 (Revised/Updated 2010-11-13) : Author: Damico and Stockstill
  • Synopsis: According to Attorney General Medicare and Medicaid fraud cost the government billions of dollars each year.

The health care debate has taken center stage in public awareness recently, but this is not the only pressing health care issue currently facing the government. In the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), many eyes are turned to the problems of Medicare and Medicaid Fraud.

Medicare and Medicaid are health care programs established by the federal government. Medicare is a health care program for people over 65 years old and for qualified people with disabilities, funded by the federal government. Medicaid is for low income people, funded by both federal and state governments. The states have most of the discretion in determining the benefits offered.

According to Attorney General Eric Holder, Medicare and Medicaid fraud cost the government billions of dollars each year. In an effort to combat these problems, DOJ and HHS have established a new task-force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Additionally, the federal government has expanded Medicare Fraud Strike Forces, which have previously proven successful.

Medicare Fraud Strike Forces

The Medicare fraud strike forces are multi-agency teams of federal, state and local investigators designed to detect and prosecute fraud. In addition to DOJ and HHS, these strike forces involve the Federal Bureau of Investigation (FBI) and the Drug Enforcement Agency (DEA). The strike forces use real time data analysis to stop fraud as it occurs.

The program has had four phases thus far:

Phase One: South Florida March 2007
- Phase Two: Los Angeles May 2008
- Phase Three: Detroit March 2009
- Phase Four: Houston May 2009

The strike forces have focused on states that spend the most money on Medicare per person. According to HHS, Louisiana spent $8,659 per enrollee in 2004, the highest in the country.

In July 2009, some of the arrests as a result of efforts of the Houston strike force were in Louisiana. Among the accused was a business allegedly giving patients "arthritis kits" that included knee braces, shoulder braces and heating pads while billing the government $3,000 to $4,000 per kit.

Types of Medicare Fraud

Medicare fraud can involve a variety of activities. Most commonly, this fraud involves the billing and coding for services, for example:

Billing for services not provided
- Billing for equipment not provided
- Billing for services that are not medically necessary
- Improperly coding for services
- Double billing

However, fraud may also involve some type of improper financial relationship between a physician and an entity providing health care. For example, an anti-kickback law prohibits any type of payment in return for referring a patient. A physician self-referral law prohibits a doctor from having a financial relationship with an entity to which he or she refers a Medicare patient.

Civil and Criminal Liability

Last year the DOJ filed 502 criminal health care fraud cases with charges against 707 defendants, ultimately resulting in 588 convictions. The average prison sentence was more than three years (37.4 months).

Many federal statutes deal with health care fraud. Some specifically apply to health care fraud, like the anti-kickback law and the law against self-referral. Others are general laws that can be applied to health care fraud, such as the False Claims Act, Racketeer Influenced and Corrupt Organizations Act (RICO) and money laundering laws.

New State-Based Medicaid Strike Force Teams

In addition to the Medicare strike force teams, DOJ and HHS are encouraging the states to establish their own Medicaid strike forces using some of the same tools used by the Medicare strike forces, such as real time data analysis. These strike forces are working together to help eliminate fraud and investigating fraudulent operators who are cheating the system and costing taxpayers money.

Recommendations

These investigations are very serious and anyone convicted of Medicare of Medicaid fraud charges faces severe consequences. If you are under investigation or have been arrested, speak to a criminal defense attorney who can provide knowledgeable guidance and protect your interests.

Article provided by Damico & Stockstill - Visit us at www.thomasdamico.com

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