A Miami grand jury late last month returned an indictment in a Medicare fraud investigation that involved approximately $1 billion in fraud, the largest such fraud case every brought by the United States. The Miami Medicare “Strike Force” was responsible for bringing this case, which involves elaborate kickback schemes, falsification of documents, submission of false claims to Medicare and Medicaid, and, tragically in some cases, the abuse of elderly Medicare beneficiaries who were cycled through nursing homes and assisted living facilities whether they needed to be there or not.
The Department of Justice created Medicare Strike Forces in two major cities approximately 10 years ago, and the Affordable Care Act provided $350 million to bring Strike Forces to seven more cities. These Strike Forces involve placing criminal fraud attorneys from the main Department of Justice in Washington within U.S. Attorney’s offices to assist Assistant U.S. Attorneys in bringing health care fraud cases or to bring cases themselves.
The indictment in this case (No. 16-20549 (S.D. Fla.)) makes for interesting reading. It describes elaborate kickback, bribery, and other fraudulent schemes involving a network of health care entities owned by the primary defendant, Philip Esformes. Mr. Esformes was reportedly worth over $75 million, and the forfeiture allegations tie him to several large homes and expensive personal property. As is typical in these large fraud cases, some details are salacious – in this one, Mr. Esformes allegedly used fraud proceeds to fly escorts to meet him at a Ritz-Carlton in Orlando.
This indictment shows that DOJ’s Medicare fraud efforts continue unabated, using the increased funding from the Affordable Care Act to continue the work that has led to the convictions of approximately 2000 defendants and the return of billions of dollars to the government. There currently is no Strike Force in Boston, as the historical strength of the health care units in the United States Attorney’s Offie here perhaps have caused officials to feel that a Strike Force commitment is unnecessary. But that of course does not mean that placement of a Strike Force here could occur in the future, particularly given the large health care industry presence in Boston. Nevertheless, prosecutors here are surely on the look-out for opportunities to bring important cases in this area.
Both the Federal and state governments have recently stepped up their efforts to address kickbacks and fraud in home health care. Home health care has become more and more prevalent as hospitals shorten patient stays. The home health area is in some ways the Wild West of health care, in that there are many different types and sizes of providers, and unscrupulous fly-by-night agencies try to take advantage of Medicare, Medicaid, and beneficiaries. The OIG alert discusses payment to physicians for Medicare beneficiary referrals and other kickback violations, as well as fraud issues such as medically unnecessary services. Enforcement efforts in this area may be a whack-a-mole situation, but these efforts are worth monitoring.
Should a home health care provider or physician need representation involving government enforcement in this or other areas, the Law Office of Mark L. Josephs is extensively experienced and ready to provide outstanding services.
he HHS Office of Inspector General recently released the results of a study examining trends in Medicare Part D spending, particularly in terms of dangers of fraud and abuse. Key findings of this study…
Prosecution of recently acquitted pharmaceutical executive did not represent a fundamental change in policy
Last Friday, a Boston federal jury acquitted Carl Reichel, former president of Warner Chilcott, of charges that he violated anti-kickback laws through sham promotional events and providing sales reps with funds to provide gifts to physicians’ offices for prescribing Warner Chilcott. As is typical in these cases, the company had pled guilty and agreed to pay a $125 million fine.