Federal Healthcare Fraud

November 20, 2014

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. Continue reading

June 13, 2014

Federal Healthcare Fraud Sentencing After Obamacare: Analyzing Title 18 USC 1347

by Peter Katz

Last week I wrote about the recent national healthcare fraud takedown by the Department of Justice and its Medicare Fraud Strike Force. We discussed the four cases brought in Brooklyn by the U.S. Attorney’s Office for the Eastern District of New York – U.S. v. Onyekwere, 14 CR 274; U.S. v. Thornhill, Thornhill and Johnson, 14 CR 278; U.S. v. Margossian; and U.S. v. Ahmed, 14 CR 277.

While these cases concern different offenses and schemes to defraud; one thing in common is the analysis that will be employed by the U.S. Attorney’s Office and the defense attorneys during plea negotiations regarding a potential sentence.

In virtually all Federal criminal cases, the Judge must consult the United States Sentencing Guidelines – this is a book that determines the seriousness of each offense as well as the criminal history of the defendant through a point (or “level”) system. The idea is to make sure similarly situated defendants are treated virtually the same by all Federal Judges throughout the country.

In determining the seriousness of the offense, the Guideline establishes a “base offense level” for every Federal crime. It then calculates “specific offense characteristics” – things that may or may not be a part of each case.

For purposes of Healthcare Fraud cases, the 2010 Patient Protection and Affordable Care Act (commonly referred to as “Obamacare”) changed, quite significantly, how that calculation is made. Continue reading

June 1, 2014

Brooklyn Medicare Fraud Strike Force: Recent Cases from the May 2014 Nationwide “Takedown”

by Peter Katz

In our last post, we discussed the history and tactics of the Department of Justice’s Medicare Fraud Strike Force. We also talked briefly about the recent Healthcare Fraud nation-wide “takedown.” But as we also mentioned, this was not one giant case involving 90 defendants, but rather dozens of cases, scattered throughout six different cities. Each one of those cases has a different history; a different story. From a practical perspective, it can be instructive to take a look at all the cases charged in a particular Strike Force city to get a feel or a sense of what types of cases are being brought there and how the government investigates healthcare fraud differently in different places. In this installment, we’ll start off by looking at the four cases brought in the Eastern District of New York in Brooklyn.

May 29, 2014

Medicare Fraud Strike Force: Healthcare Fraud Prosecutions in 2014

by Peter Katz

In March 2007 the Medicare Fraud Strike Force originated in South Florida as a ground-breaking joint effort between the U.S. Department of Justice’s Criminal Division Fraud Section, the U.S Attorney’s Office for the Southern District of Florida, Health and Human Services Office of Inspector General, as well as state and local law enforcement agencies to prosecute individuals and businesses that did not provide legitimate health care services, but existed and operated for the sole purpose of stealing money from the Medicare coffers.

Over the last seven years, this first-of-its-kind strike force in the health care arena has become a model of innovation in terms of strategy, methodology and practice, but also quite some controversy. According to the Department of Justice, as of early 2014, the Strike Force, now in nine cities, has charged more than 1400 defendants, who have collectively billed the Medicare program for more than $4.8 billion. In addition, hundreds of millions of dollars have been returned to the Medicare Trust Fund through restitution and forfeiture. The question has been asked, however, whether the government has overreached in some of these healthcare fraud investigations and prosecutions. This aggressive approach smells from governmental over-reach, and requires anyone charged in a Strike Force case to seek out a Federal Criminal Attorney well experienced in Healthcare Fraud matters to present an effective defense.