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Thirty individuals get a $61 Million bill

Thirty people just received a rather large “HEAT” bill, courtesy of the joint DOJ-HHS Medicare Fraud Strike Force, aka HEAT, a team of federal, state and local investigators from multiple agencies designed to combat Medicare fraud through the use of Medicare data analysis techniques, combined with “community policing,” more commonly known as whistleblower lawsuits. Strike Force teams now operate in seven cities: Miami, Los Angeles, Detroit, Houston, and the newest operations just announced in Brooklyn, Tampa and Baton Rouge.

This is just the most recent announcement about the team that has indicted more than 460 people and organizations since 2007, claiming they fraudulently billed Medicare for more than $1 Billion.

The team originally operated in only four major cities, but their recent success has spawned their expansion into the three new locations.

Fraud Targets

What do they look for? Here’s a short list of these most recent allegations, to give you a sense of what they target:

• Nerve Conduction Studies — to justify such testing, patients were paid kickbacks to feign symptoms.
• Shoe Inserts for diabetes patients — billing for such DMEs when much less expensive over-the-counter items were actually provided to the patients, or when the DMEs were not really medically necessary (i.e., the over-the-counter items would have sufficed, according to the feds).
• HIV Infusion Services — billed, but found to be either medically unnecessary and/or never provided.
• Home Health Services — billed, but found to be either medically unnecessary and/or never provided.

We bring to your attention the phrase so often seen these days in both denials and fraud allegations: medically unnecessary.  Huge issue, which should not be a surprise to any of our readers.

Criminal Allegations

Here are the specific crimes listed in the HHS press release:

• conspiracy to defraud the Medicare program
• conspiracy to launder money
• money laundering
• criminal false claims
• making false statements
• receiving kickbacks.

HEAT Expands

Want to know more?  Click HERE to read more background on HEAT and see their website.

Want to know if HEAT is coming to a city near you?  Click HERE where you can see what HEAT is doing in YOUR state.

Tags: DOJ, healthcare fraud, healthcare fraud prevention and enforcement action team, healthcare reform, HEAT, HHS, medicare fraud

This entry was posted on Monday, December 21st, 2009 at 1:54 pm and is filed under From the road..., Medical Coding News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.