Federal Healthcare Fraud Investigations on the Rise

Recently, we discussed the history of the Medicare Fraud strike forces set up by the U.S. Department of Justice, Fraud Section, in an effort to combat what was perceived as rampant fraud in the healthcare system.  Recently, local U.S. Attorneys across the country have copied the structure and format of the strike forces within their own offices.

Take for example David Hickton, the U.S. Attorney for the Western District of Pennsylvania, in Pittsburgh, who created his own “mini-strike force.”  He has enlisted four assistant U.S. attorneys from his office to focus exclusively on health care fraud investigations and prosecutions.  He has support from the Pittsburgh Division of the FBI, which is one of the two federal law enforcement agencies charged with investigating health care fraud.  He has also reached out to the HHS-OIG, the Department of Health and Human Services, Office of the Inspector General, the other federal agency investigating the medical industry, asking them to dedicate special agents to the Pittsburgh area.

The idea is to focus manpower on one of the largest and most complex industries in the country in an effort to gain expertise while eradicating millions, if not billions of dollars of fraud, waste and abuse in the healthcare industry.

As mentioned above, and in previous posts, this is not a novel idea.  Main Justice has been using this formula very successfully for the last several years.  In fact, since their inception in 2007, Strike Force operations in nine locations across the country have filed charges against approximately 1,900 defendants for over $6 billion in fraudulent billings.

What is interesting is that smaller federal prosecutor offices, such as in Pittsburgh, are starting to see the benefits of setting up a strike force to tackle health care fraud.  Other offices around the country – such as in Philadelphia, New Jersey, Detroit, Virginia and Miami – are models for these other offices.  In Philadelphia, U.S. Attorney Zane Memeger has filed actions against doctors, big pharma, ambulance companies, home health agencies, physical therapy clinics and the like.  Take two recent cases:  Johnson and Johnson has paid $2.2 billion in fines and restitution for illegal kickbacks and marketing regarding several anti-psychotic medications.  A hospice owner was sentenced to 14 years in prison and ordered to pay over $16 million in restitution to Medicare after being convicted at trial of submitting false and fraudulent billings over many years.

These offices, however, have to be careful not to cast too wide of a net – and target lawful individuals, businesses and entities – just in an effort to get publicity or million dollar recoveries without having the proof to back it up.

If you are a healthcare provider – whether as a doctor, nurse, physical therapist, home health care worker or owner—you should be well aware that the federal government continues to flex its muscle in an attempt to eliminate healthcare fraud.  Unfortunately, however, sometimes they target the innocent and law abiding.  Some prosecutors end up playing fast and loose with the facts and evidence, others don’t necessarily understand the complexities of healthcare regulations, still others charge individuals who may not have had any criminal intent whatsoever.

Whatever the circumstance, if you find yourself on the opposite side of the government – whether you’ve received a subpoena from a federal prosecutor or law enforcement agency or an agent has knocked on your door, or you have been arrested, it is now, more than ever, critical that you contact an experienced healthcare fraud defense attorney to assist you.

The federal government is not going to abandon the healthcare industry anytime soon.  To the contrary, more and more resources, throughout the country, will be devoted to rooting out fraud, waste and abuse.  You just want to make sure you are not caught up in such an investigation.  And if you are, reach out to an attorney well versed in federal healthcare fraud investigations and prosecutions such as those at Saland Law PC.

To read more about Federal Healthcare Fraud crimes, review this blog and the Saland Law PC website.

To learn more about Federal Healthcare Fraud crimes, contact Saland Law PC or follow the links throughout this blog entry.  A Federal criminal defense law firm located in lower Manhattan, the Federal criminal defense attorneys and former health care fraud prosecutors at Saland Law PC represent clients throughout the New York-New Jersey metropolitan area, as well as nationwide.




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