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The Federal Government Is Finding New, Aggressive Ways to Combat Home Health Fraud

Categories: Health Care Fraud

Texas Tricare Fraud Attorneys - Oberheiden & McMurrey, LLP

 

Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
1-800-810-0259
Including Weekends

The home health services industry has undergone exponential growth in recent years as a less expensive alternative to in-patient rehabilitation and geriatric care services. Medicare will even compensate friends and family members of patients for the provision of home health services. With the increased expenditures by government healthcare services on home health services, government agencies are increasingly focused on monitoring and investigating home health service providers for healthcare fraud. The Department of Justice (DOJ) has publicly acknowledged its goal of taking a more strategic approach to addressing healthcare fraud, particularly in the area of home health services, in contrast to its historically passive approach, often referred to as “pay and chase.” To this end, federal officials have started employing new ways to investigate individuals suspected of defrauding Medicare, Medicaid, and other government beneficiary programs.

Joint Task Forces

In 17 cities across the nation, federal and local officials have combined efforts in Medicare Fraud Strike Force teams. The Strike Force teams include agents from the DOJ, the Department of Health and Human Services (DHHS), the Federal Bureau of Investigation (FBI), and local law enforcement. Between 2007 and 2015, these multi-agency task forces have arrested more than 2,300 individuals for healthcare fraud representing more than $7 billion in false claims to the government.

In Dallas, for example, the U.S. Attorney’s Office for the Northern District of Texas oversees a Medicare Fraud Strike Force that includes representatives from the FBI, DHHS, and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU). The North Texas Strike Force was recently responsible for uncovering the largest home health fraud scheme ever, involving approximately 11,000 Medicare patients and almost $375 million in fraudulent claims. https://www.justice.gov/usao-ndtx/pr/dallas-doctor-and-three-dallas-area-home-health-agency-owners-convicted-running-large

Similarly, the DOJ and the DHHS have teamed up to create the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which oversees the various Medicare Fraud Strike Force teams. The coordinated efforts of HEAT are aimed at preventing healthcare fraud and enforcing anti-fraud laws. In June 2015, HEAT lead a nationwide sweep of healthcare fraud perpetrators that resulted in the arrest of 243 individuals representing $712 million in false claims, including multiple home health services providers charged with bilking tens of millions of dollars from the federal government. https://www.justice.gov/opa/pr/national-medicare-fraud-takedown-results-charges-against-243-individuals-approximately-712

Undercover Informants

Federal investigators are increasingly using undercover informants to investigate home health agencies suspected of engaging in healthcare fraud. Such informants have posed both as patients and as service providers to catch perpetrators of home health fraud red-handed. In recent years, confidential informants have aided law enforcement officials in multiple high profile home health fraud busts, including the following examples:

  • In August 2015, the CEO of a Chicago home health agency was charged with Medicare fraud after billing Medicare for thousands of dollars’ worth of unnecessary services for an undercover informant posing as a patient. https://www.fbi.gov/chicago/press-releases/2015/ceo-of-chicago-based-health-care-company-charged-with-billing-medicare-for-phony-and-non-existent-treatment-of-the-elderly-in-1.2-million-scheme
  • In April 2015, the owner of a New Jersey home health agency pled guilty to defrauding Medicaid out of $7 million after she revealed her fraudulent scheme to a cooperating witness posing as a home health aide. https://www.fbi.gov/newark/press-releases/2015/owner-of-home-health-care-agency-admits-fraud-bribery-and-other-charges

New Technology

Over the past few years, the Centers for Medicare and Medicaid Services (CMS) have begun using a newly developed Fraud Prevention System (FPS) software that helps identify fraud patterns in healthcare billing through the use of predictive analytics. The FPS analyzes data both in real time and retrospectively to uncover suspicious billing practices. According to CMS, the FPS was responsible for identifying or preventing $820 million in improper claims in its first three years of implementation. The information obtained by CMS through FPS is passed on to law enforcement agencies for use in investigating and prosecuting the individuals suspected of submitting improper bills. CMS officials have announced their intent to expand the use of FPS to identify lower levels of non-compliant health care providers. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-07-14.html

Proposed Measures

CMS has recently sought approval from the Office of Management and Budget to launch a new, additional anti-fraud initiative called the Medicare Probable Fraud Measurement Pilot. The proposed program is specifically designed to target home health agencies and would require them to obtain prior authorization from CMS before being able to process claims for services. Similar anti-fraud programs have been implemented by TRICARE, private healthcare companies, and even CMS with regards to motorized scooters and wheelchairs. If passed, the Medicare Probable Fraud Measurement Pilot would take effect in the five states with the highest rates of home health fraud – Texas, Florida, Illinois, Michigan and Massachusetts. https://www.federalregister.gov/articles/2016/02/05/2016-02277/agency-information-collection-activities-proposed-collection-comment-request

What Does this Mean for You?

If you believe that you are under investigation for home health fraud, you should contact an attorney at your earliest opportunity. The state and federal officials are using coordinated, aggressive and covert techniques to identify, investigate, and prosecute individuals suspected of participating in home health fraud. The sooner you obtain legal representation, the more likely you will be to avoid or minimize any potential charges against you.

Our Experience

At Oberheiden & McMurrey, LLP, our experienced defense counsel and former federal prosecutors routinely receive calls from clients around the country for assistance in their times of need. The strength of the firm is based on three prongs: our industry knowledge, our government experience, and our ability to keep investigations from becoming criminal.

  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.

Our Team

  • Dr. Nick Oberheiden has successfully defended healthcare executives, physicians, and pharmacies against kickback, prescription fraud, false claims, and fraud allegations before the Office of Inspector General (OIG), Department of Justice (DOJ), Department of Defense (DOD), IRS, FBI, DEA, and other agencies. He is trained in negotiations by Harvard Law School and he received his Juris Doctor from UCLA School of Law as well as a PhD in law from the University of Heidelberg.
  • Attorney Lynette S. Byrd focuses her practice on civil and criminal litigation, Medicare and insurance audits, and general advice and counseling in health care law. She is a former Assistant United States Attorney with years of substantial trial experience under her belt who merges excellent litigation skills with profound understanding of the law.

Free Consultation

If you would like to talk to someone who understands how to effectively defend against government investigations, you should consult with former federal prosecutor Lynette S. Byrd of Oberheiden & McMurrey, LLP. All inquiries are free and confidential.

Oberheiden & McMurrey, LLP
Criminal Defense – Healthcare Law – Litigation
(800) 810-0259
(214) 469-9009
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
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