OIG Increasing Efforts to Combat False Billing in Arkansas, Louisiana
With a heavy sigh, William W. Root knocked on the front door of the home of yet another Medicare beneficiary who had been prescribed an expensive electric wheelchair. It was springtime; buds were popping out everywhere. After flashing his credentials, Root was invited inside, where he eyed a year-old, unused wheelchair sitting in a corner of the living room with a potted plant in the seat.
He shook his head. As suspected, the Medicare beneficiary hadn’t ordered the wheelchair, didn’t need it, and when it arrived simply found a place to store it.
Root, who has worked healthcare fraud cases since 1981, recognized the prescribed wheelchair as part of a durable medical equipment (DME) scheme the U.S. Department of Health and Human Services (HHS)-Office of the Inspector General (OIG) was investigating in Baton Rouge, La. Data-driven information had alerted the Office of Investigations of uncommonly high DME activity in the area.
He also knew that unfortunately, the plastic wrapping had been removed from the wheelchair, which meant that even though it was unused, it wasn’t suitable to donate to the Department of Defense’s Wounded Warrior Program.
“It’s really disheartening to visit these beneficiaries who were completely in the dark and had no idea that Medicare had paid $6,000 for something that someone else who didn’t qualify might actually need,” said Root, assistant special agent in charge of Louisiana and Arkansas for the HHS-OIG regional office in Dallas. “Add to that, some doctors were getting referral fees of $500 per script for an unnecessary wheelchair. Some were writing 200 scripts a year. That’s sad.”
On July 16, the Medicare Fraud Strike Force made national headlines when 94 doctors, healthcare company owners, executives and others were charged for more than $251 million in alleged false billing. In Baton Rouge alone, 29 defendants were charged for various schemes allegedly involving fraudulent claims for DME totaling approximately $32 million. Two defendants were charged in two cases.
“This represents the largest healthcare fraud initiative in the history of the Middle District of Louisiana,” noted U.S. Attorney Don Cazayoux Jr.
Of the 29 defendants, four were doctors, 14 were patient recruiters, and the remainder represented individuals who allegedly worked at the medical services companies.
“I’m often asked specifically by physician groups about the percentage of cases that involve physicians. It’s very small,” said Root. “The Medicare system is set up where we rely on a physician’s order for a lot of services and products delivered. Unfortunately, there are a few physicians who will give in to the greed factor and participate in the fraud against Medicare, especially in DME.”
The operation involving nearly 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies signaled the largest federal healthcare fraud takedown since Medicare Fraud Strike Force operations began nationwide in 2007. Medicare fraud-related offenses include conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home healthcare schemes, HIV infusion fraud schemes, and DME schemes.
“Our continued Strike Force operations reflect the unprecedented commitment that inspired the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in May 2009,” said Attorney General Eric Holder. “We’re putting would-be criminals on notice … healthcare fraud is no longer a safe bet. The federal government is working aggressively–and collaboratively–to pursue healthcare criminals around the country and to bring these offenders to justice.”
Since its inception in March 2007 in South Florida and continuing through its most recent expansion into Tampa, Fla., the Strike Force has obtained indictments of more than 800 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s Centers for Medicare and Medicaid Services (CMS), working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
HHS Secretary Kathleen Sebelius credited the new tools in the Affordable Care Act—stiffer penalties and better information sharing—with helping to “stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”
In February, Baton Rouge became home to the nation’s eighth Strike Force.
“We’d been working some DME cases against other providers,” said Root. “This was a different challenge putting together a team effort in these investigations. It’s helped us move quicker.”
Last month, trial began in the first Department of Justice (DOJ) case—against Alpha Medical Solutions in Baton Rouge.
“Many of the subjects have entered into plea agreements and are cooperating with us,” said Root. “We’ll have several spinoff cases as a result of the Strike Force effort where we’ve learned about other providers who have or are committing fraud against the government. We hope to have another takedown date next spring.”
In Arkansas, Root said possible fraudulent activity “hasn’t jumped off the charts as it has in other states and cities.”
“However, Arkansas is being reviewed, and we have a very good data mining team and we’re making great headway there,” he said. “We’re expecting a whole lot more law enforcement efforts against healthcare fraud in Arkansas over the next couple of years.”
As medical companies and practices adopt electronic health record (EHR) systems, electronic recordkeeping will help stop fraud, waste and abuse, said Root.
“If we could get a better handle on controlling, this program could be more beneficial,” he added. “The bottom line is, if we let people continue to pilfer the trust fund, the chances of there not being a lot left when we retire is a bit scary. We all need to take an active role in protecting the government resources. The medical community in Louisiana and Arkansas should know that they can reach out to us, and they should report anything that doesn’t seem right, no matter how minor they believe the infraction. It could be part of something larger, which would be very beneficial to all of us.”
For more information on the DOJ/HHS Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative that includes Medicare Fraud Strike Force teams, visit www.stopmedicarefraud.gov.
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