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AGENCY PROFILE: MEDICARE FRAUD STRIKE FORCE

This is the first article in an educational series to appear on the MDRXLaw Blog, profiling various regulatory and law enforcement agencies and entities relevant to health care providers. Given the number of agencies and entities having jurisdiction over health care providers, the individual role played by each can often be unclear. This post will profile the Medicare Fraud Strike Force, an interagency law enforcement collaboration.

In the wake of the recent health care fraud sweep, covered here, we have received many inquiries from clients about the Medicare Fraud Strike Force.

The Medicare Fraud Strike Force is comprised of investigators and prosecutors from the Office of the Inspector General, the Department of Justice, the Offices of the United States Attorneys, the Federal Bureau of Investigation, and state and local law enforcement. It targets Medicare fraud allegedly committed by physicians, physical therapists, home health agencies, pharmacies, DME companies and other licensed health care providers and businesses.

The Strike Force operates in Brooklyn, Baton Rouge, Chicago, Dallas, Houston, Detroit, Los Angeles, Miami and Tampa Bay.These nine cities are the so-called "HEAT zones", named for the larger initiative which the Strike Force is a part of: the Health Care Fraud Prevention and Enforcement Action Team (HEAT).HEAT itself is a joint initiative directly under the Cabinet-level supervision of the Unites States Attorney General and the Secretary of Health and Human Services. The expectation is that additional HEAT zones will be established going forward.

As a result of its interagency nature, the Strike Force has multiple enforcement tools at its disposal.In addition to bringing about criminal and civil charges, the Strike Force can also refer allegations of fraud to the Centers for Medicare & Medicaid Services, who in turn can suspend payments to providers.

While the Strike Force's recent action may have been the largest in history, it was not the first. In June 2015, the Strike force arrested 243 individuals for approximately $712 million in false billing; in May 2014, the Strike Force conducted a 90-person, $260 million takedown in six cities.As the Federal government places increased emphasis on Medicare fraud, these sweeping takedowns can be expected to come with increased frequency.

If you have any questions or require legal guidance with respect to a Medicare/Medicaid investigation or dispute, please do not hesitate to call one of our experienced healthcare attorneys at 212.668.0200 or email the firm at info@mdrxlaw.com. Our healthcare partners have years of experience representing providers and facilities in Medicare and Medicaid criminal and civil investigations, billing disputes and appeals, as well as general litigation, and defense of healthcare providers in civil, administrative, disciplinary and criminal proceedings.

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Tuesday, January 21, 2020