Detroit Medicare Strike Force
A Major Crackdown
On Health Care Fraud
This afternoon, we joined with the Department of Justice and the Department of Health and Human Services in announcing the unsealing of indictments against 53 people in a combined enforcement effort specifically targeting fraud schemes that threaten Medicare…and our country’s most vulnerable citizens—seniors, people with disabilities, and low-income Americans.
Agents from the FBI and the Health and Human Services (HHS) Inspector General’s Office have already begun arresting the defendants in Detroit and Miami. These defendants were the subjects of several separate health care fraud investigations by the new Detroit Medicare Fraud Strike Force, comprised of FBI and HHS agents and Department of Justice (DOJ) prosecutors. Combined, the subjects are accused of conspiring to submit more than $50 million in false claims to Medicare.
Today’s arrests involved at least nine Medicare provider companies and a number of company executives, doctors, therapists, medical recruiters, medical assistants, and even some Medicare beneficiaries who were willing to go along with the schemes in exchange for money.
The two primary types of fraud schemes being perpetrated include:
- Physical therapy/occupational therapy fraud: The crux of these schemes was billing Medicare for services not rendered. In most cases, the subjects created fictitious patient files by paying Medicare beneficiaries, therapists, and doctors to fill out and sign documentation indicating services had been provided when in fact they had not been. These phony files were then systematically distributed to Medicare providers for illicit billing.
- Infusion therapy fraud: Several Michigan infusion therapy companies providing medication for AIDS, HIV-positive, and Hepatitis C patients were allegedly billing Medicare for services not actually performed, were medically unnecessary, or were medically unlikely (medicines not normally prescribed for particular conditions). Note: infusion therapy involves giving medicine intravenously to patients whose conditions are so severe they can’t be treated with oral medication.
To investigate health care fraud, Director Robert Mueller said that the FBI is focused on “partnerships, intelligence, and information-sharing.” He also explained how our sophisticated investigative techniques—from undercover operations to wiretaps—can be used to “not only collect evidence for prosecution, but to find and stop criminals before the schemes spread.”
Officials announcing the indictments included, from left, Robert Mueller,
Bringing the HEAT. Today’s announcement came a month after Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the creation of a task force—the Health Care Fraud Prevention and Enforcement Action Team, or HEAT—to continue ramping up coordinated efforts against health care fraud. HEAT is comprised of DOJ and HHS senior leaders who will work towards increasing cooperation, intelligence sharing, and training among their investigators, agents, and prosecutors. Medicare strike forces will figure prominently in HEAT’s efforts.
The first such strike force was established in Miami in 2007, followed by a second in Los Angeles and two more recently in Detroit and Houston—all areas of the country with concentrated Medicare fraud activity. And just yesterday, indictments in a $100 million Medicare and Medicaid scheme were announced in Miami.
Health care fraud, according to Director Mueller, is “not a victimless crime—every person who struggles to pay for health care benefits; every older person who worries about Medicare’s ability to cover them; every taxpayer who helps fund these programs—they are all victims.” All good reasons why we take our responsibility to investigate health care fraud very seriously.