What is the Medicare Fraud Strike Force?

By Susan Schneider Thomas

Although fraud against the federal and state governments occurs in many different industries, there is always a lot of attention paid to healthcare fraud because it involves such enormous government expenditures, and it has such a huge impact on the beneficiaries of government healthcare programs. That impact can be through compromised healthcare or fraud of government resources that constricts the government’s ability to provide services. The federal Medicare Fraud Strike Force Teams are one example of the resources that the federal and state governments bring against individuals or companies that attempt to defraud government healthcare programs.

What Do Medicare Fraud Strike Force Teams Do?

Medicare Fraud Strike Force Teams combine federal, state, and local law enforcement resources to target and prosecute healthcare fraud, waste, and abuse. Strike Force teams utilize sophisticated data analytics and cutting-edge investigative tools to pinpoint and prosecute unscrupulous doctors, other healthcare providers, and the many institutions and entities that provide healthcare, including:

-hospitals

-medical laboratories

-pharmaceutical and medical device manufacturers

-ambulatory surgical clinics

-ambulance companies

-hospice care providers

-home health agencies

-physical therapy practices

Although these teams currently only operate in limited locations identified as having substantial instances of healthcare fraud, the entire program demonstrates the government’s commitment to weeding out and penalizing the entities and individuals who defraud government healthcare programs.

Medicare Fraud Strike Force Teams and Other Government Agencies

Strike Force Teams can bring together the efforts of the Department of Justice and its local Offices of the United States Attorneys, as well as the Federal Bureau of Investigation, the Office of the Inspector General, and others. These teams have been successful at analyzing data and market intelligence to identify fraud and prosecute the wrongdoers.

One useful impact of the collaboration among different agencies is that credible fraud allegations can be brought to the attention of the Centers for Medicare & Medicaid Services (CMS), which can suspend payments to the suspected perpetrators. If the fraud is proven and sufficiently serious, the perpetrators can be excluded from further participation in federal healthcare programs.

Report Suspected Healthcare Fraud

If you have information about suspected healthcare fraud, please contact Berger & Montague immediately so we can investigate and help to evaluate your potential claims. Your suspicions may be aroused by conduct you observe at work, like constant pressure to bill at the highest possible rates, regardless of services actually needed or provided.

You may see billing patterns for prescription drugs or medical devices that do not jive with what you had seen at a prior place of employment, like irresponsibly high prescribing rates for opioids that are not needed or possibly not even dispensed.

Perhaps you are a client of or a provider to a company whose practices appear to violate federal regulations or healthcare standards, such as an employee at a nursing home who is always pressured by an ambulance transport company to certify that patients are not ambulatory – even when they are.

Or perhaps you’re the person who sees a physician provide false certifications authorizing home healthcare services for thousands of Medicare beneficiaries, leading to hundreds of millions of dollars in false claims being submitted to the government.

Once we have sufficient information from you, we can work with you to bring meritorious claims to the attention of the federal government – and possibly put you in a position to be rewarded for your efforts through the Federal False Claims Act. The government’s enforcement efforts are often triggered by or vastly assisted by information that people in the industry can provide.

If you have discovered evidence of fraud committed against the government, you may be entitled to a substantial reward and the legal protections afforded to whistleblowers under state and federal laws. The attorneys at Berger & Montague are nationally recognized for their work in Whistleblower/Qui Tam actions. For more information or to schedule your confidential consultation, contact us online or call us at 888-647-9292.

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By | 2018-03-25T12:47:02+00:00 October 16th, 2017|Healthcare Fraud|