The Largest Takedown in Medicare Strike Force History and Your Health Care Practice: The Next Layer of Compliance Guidance
In the largest federal health care takedown in the history of the Medicare Fraud Strike Force, ninety-four people throughout Baton Rouge, Brooklyn, Detroit, Houston and Miami were charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program
The charges stemmed from various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statute and money laundering. The false claims identified and targeted by the Medicare Fraud Strike Force directly mirror the “issues under review” identified by Medicare’s Recovery Audit Contractors (“RACs”), including the RAC for Region A (covering New York and New Jersey). Practices looking to identify procedures and/or services that are being targeted by auditors, investigators and/or reviewers should see the issues under review for their regional RAC and, in particular, the targeted abuse discussed by the RAC.
In this historic takedown, the Medicare Strike Force identified participation in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided for the following procedures and/or services:
- physical therapy and occupational therapy schemes
- home health care services
- HIV infusion fraud
- Durable Medical Equipment (DME)
- Nerve conduction tests
- IV infusion therapy
