Strike Force Targets Medicare Fraud

Eleven people have been indicted in the second phase of a targeted criminal, civil, and administrative effort against individuals and healthcare companies that fraudulently bill the Medicare program, Assistant Attorney General of the Criminal Division Alice S. Fisher and U.S. Attorney for the Central District of California Thomas P. O'Brien announced.

The indictments in the Central District of California resulted from the creation of a multi-agency team of federal, state, and local investigators designed specifically to combat Medicare fraud through the use of real-time analysis of Medicare billing data. The first phase of the strike force began operating in Miami-Dade County on March 1, 2007, and has secured more than 100 convictions to date related to fraudulent Medicare billing.

Since phase two of strike force operations began in Los Angeles on March 1, 2008, the strike force has obtained indictments of individuals and organizations that collectively have made almost $13 million in fraudulent claims to the Medicare program. Charges brought against the defendants in these indictments include conspiracy to commit health care fraud, advising or participating in a scheme to defraud a healthcare benefit program, and aggravated identity theft. If convicted, many of the defendants face up to ten years in prison. All indictments also seek forfeiture of the criminal proceeds.

"The indictment of 11 defendants and execution of six warrants mark phase two of the Medicare Fraud Strike Force, which focuses resources to target Medicare fraud as it is occurring. The Strike Force has been successful in recovering millions of dollars that were bilked from the Medicare program and in convicting more than 100 wrongdoers in Miami," Fisher said. "We are pleased to be working with our partners in Los Angeles to investigate and prosecute those who attempt to defraud the Medicare program."

The strike forces can identify potential fraud cases for investigation and prosecution quickly through real-time analysis of billing data from Medicare Program Safeguard Contractors and claims data extracted from the Health Care Information System. In phase two, prosecutors, agents, and analysts from federal law enforcement and government agencies are analyzing claims data to determine unusual billing patterns to identify possible fraudulent activity. Based on identified irregular patterns, the strike force investigates individuals and/or companies that may be involved in submitting false claims to the Medicare program.

On May 8, 2008, federal agents executed four search warrants, two seizure warrants, and arrested ten people in the first round of arrests resulting from phase two of the Medicare Fraud Task Force. Defendants taken into custody in the sweep were arrested for submitting false claims to the Medicare program for wheelchairs, orthotics, and other durable medical equipment (DME) that was medically unnecessary and/or not provided to the beneficiaries identified in claims.