Healthcare fraud enforcement is a top priority for the U.S. government. There are billions of dollars in programs and reimbursement measures, not to mention millions of patients and healthcare practitioners that utilize them. Because of the government’s investment in federal healthcare programs, many agencies are responsible for enforcing various aspects of fraud and abuse. One such agency is the Medicare Fraud Strike Force.
This agency is a joint effort between the Department of Justice (DOJ) the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). The Medicare Fraud Strike Force is a team of federal, state, and local investigators using Medicare data analysis to combat Medicare fraud in critical hotspots around the country. Since 2007, areas of operation have expanded to cover regions and cities across the country, including:
- Los Angeles, California
- Detroit, Michigan
- Brooklyn, New York
- Baton Rouge and New Orleans, Louisiana
- Miami, Tampa, and Orlando, Florida
- Chicago, Illinois
- Dallas and Houston, Texas
- Washington, D.C.
- Philadelphia, Pennsylvania
- The Appalachian Region
- The Gulf Coast
These teams only operate in the listed areas and have their specialties, but they are well-funded and represent the federal government’s willingness to investigate healthcare fraud around the country. The teams are located in areas of exceptionally high levels of Medicare fraud, and they also track emerging schemes that move from community to community. As of September 2020, the Medicare Strike Force has cumulatively uncovered over 2,300 criminal actions, led to over 3,000 indictments, and recovered over $3.8 billion.
What Do Strike Force Teams Investigate?
Strike Force teams identify and eliminate healthcare fraud, waste, and abuse. They use data analytics and local investigators to prosecute doctors, providers, and other healthcare organizations. These include:
- Medical Labs
- Pharmaceutical Companies
- Medical Equipment Manufacturers
- Home Health Agencies
- Physical Therapy Practices
Common examples of Medicare fraud include billing for services not provided, charging extra for services provided, changing billing codes to receive more Medicare reimbursements, and charging for unnecessary services. On top of fraud, Strike Force teams look into illegal prescriptions, especially opioids.
They also investigate Anti-Kickback Law violations, Stark Law violations, False Claims Act violations, Qui Tam suits, money laundering schemes, and insurance fraud. Kickbacks include exchanging anything of value in return for federally reimbursable referrals. Stark Laws prohibit referring to any entity where a practitioner’s family member has a financial interest. Qui Tam suits are a type of whistleblower suit that involves a private individual representing the government against a healthcare practice.
Billing patterns can trigger strike Force investigations picked up by federal and state investigators. These investigations could be a single practice or an ongoing one into multiple healthcare organizations. They can also result from a whistleblower claim against a healthcare company or practitioner or a tip provided by a patient who may have been on the receiving end of fraudulent service.
Consequences of a Medicare Fraud Strike Force Investigation
There are many potential consequences when a Strike Force investigation is underway. The most common penalties include criminal charges, prison sentences, fines, civil fees, and exclusion from federal programs. General Medicare fraud schemes carry hefty punishments, and those convicted of Medicare fraud can face up to 10 years in prison, as well as fines up to $250,000. These numbers increase if a fraud scheme leads to injury or death.
Accusations that fall under the False Claims Act can lead to criminal charges, prison sentences of up to five years, and fines up to $250,000. Kickback violations can net the same punishment, with the added penalty of being barred from future participation in Medicare programs and reimbursements.
On top of criminal charges and incarceration, there are also civil fines to consider. The fine per false claim is $11,000, and the fine for each kickback is $50,000. Based on a practitioner’s alleged misconduct, the federal government can increase or add to these fines as well. Stark Law violations carry only civil penalties, but they are not small. Fines can be $15,000, with three times in payment and penalties up to $100,000 per scheme.
What to do if You Are the Target of a Medicare Fraud Strike Force Investigation
The healthcare industry is one of the most heavily regulated fields. With the vast array of laws that organizations and practitioners are subject to, on top of changing Medicare compliance requirements, healthcare companies face potential dangers at the federal and state level. Falling on the wrong side of these regulatory bodies can damage a healthcare company for years to come.
Suppose you are a doctor, healthcare provider, or any other healthcare group or company facing allegations that could lead to a Strike Force investigation. In that case, your first step should be to get in touch with healthcare defense attorneys immediately. A healthcare defense attorney can help make sure that you understand what is involved in your particular case and gather any documents and witnesses you may need to defend yourself.
At Norman Spencer Law Group, we have experience in healthcare fraud defense that you can rely on. Our team has handled various healthcare defense cases, and we have in-depth knowledge of healthcare law to help you navigate a Medicare Fraud Strike Force investigation. Call us to set up a free consultation and go over your options. We can have a team member meet with you over the phone, on ZOOM, no matter where you are located.
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