“Sweeps” among law enforcement are generally used in high drug crime areas to literally sweep in and arrest as many people as possible to clear out the drug dealing in that area.
In a modification of the theme, the State of Florida Agency For Health Care Administration (AHCA) decided to conduct an auditing sweep of durable medical equipment (DME) providers in Bay County, Florida. AHCA is the Florida Medicaid program administrator, and has the authority under Florida law to initiate overpayment actions or terminate a program provider, but is not a law enforcement authority, referring instances of fraud to the Attorney General’s Medicaid Fraud Control Unit. The probe was directed to supplies of oxygen to patients with COPD under the Medicaid program.
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Monthly Archives: May 2009
The HEAT is on as Feds Launch Crackdown on Healthcare Fraud
According to a press release, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder launched an interagency high-level task force to help detect and prevent health-care fraud, which robs the nation’s coffers of billions of dollars each year.
The Department of Justice and Department of Health and Human Services directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where “erratic” billing data suggest high levels of fraud, waste and abuse in Medicare and Medicaid programs. The first of these task forces was launched in Miami and then expanded to Houston and Los Angeles.
The new task force, the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, would be run from the highest levels of government. The Health Care Fraud Prevention and Enforcement Action Team will be composed of senior-level officials at the Justice Department and HHS. The group will use electronic claims data, as well as the threat of federal prosecution, to look for unusual billing problems.
To read more about about the HEAT initiative, click here and here.
Wyeth Gets Agita From Whistleblower Law Suit Seeking Hundreds Of Millions For Stomach Acid Medication Rebates
The Justice Department and 16 Attorneys General joined a whistleblower lawsuit alleging that Wyeth Labs offered lower prices on two prescription drugs that were not offered to the Medicaid Programs of the various states avoiding hundreds of millions of dollars in rebate payments owed to state Medicaid Programs. Under the Medicaid rebate programs of most states, manufacturers are required to offer the same discount pricing to the program as they do to customers. The suit alleges hospitals received steep discounts that were not provided to the states in order to gain access to hospital patients.
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Number of Medicare Fraud Fugitives Leads To Stricter Supervision Of Charged Defendants
Some 60 defendants charged with Medicare Fraud in the Southern District of Florida have fled pending trial since 2004. Many who have fled are of Cuban origin, leading authorities to conclude that they have returned to Cuba, which is generally out of reach of U.S. law enforcement.
Previously, defendants were able to be released on minimal restrictions. However, over the last year judges in the Southern District have been denying bond and placing significant restrictions on defendants to assure the presence of Medicare fraud defendants.
In another very good article, Jay Weaver of the Miami Herald, breaks down the fugitive life of one such defendant, Alcides Garcia, originally believed to have fled to Cuba but who had traveled to Mexico, Spain and was eventually arrested in the Canary Islands.
To read more click here.
Medicare Errors Account For $2.8 Billion A Year
One study by CMS found that up to 70% of payments for some medical equipment should not have been due to a failure to document the medical necessity for the equipment provided under CMS guidelines. In 2008, the errors resulted in $2.8 billion. A representative of CMS indicated that the numbers were not actual fraud, but the error rates made fraud more likely. A new program is of regional bidding for DME suppliers is expected to begin in 2010.
To read more, click here.