Deeper Than the Headlines: Medicare Fraud Strike Force Announced a New Location

The U.S. Department of Justice has recently announced another location for a Medicare Fraud Strike Force.  This newest location is the Newark/Philadelphia Regional Medicare Fraud Strike Force.

Medicare Fraud Strike Force Teams harness data analytics and the combined resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse.

First established in March 2007, Strike Force teams currently operate in 10 areas: Miami, Florida; Los Angeles, California; Detroit, Michigan; southern Texas; Brooklyn, New York; southern Louisiana; Tampa, Florida; Chicago, Illinois; Dallas, Texas; and Newark, New Jersey/Philadelphia, Pennsylvania. The Newark/Philadelphia regional Strike Force location was formed in August 2018.

Strike Force teams bring together the efforts of the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, local law enforcement, and others.

These teams have a proven record of success in analyzing data and investigative intelligence to quickly identify fraud and bring prosecutions. The interagency collaboration also enhances the effectiveness of the Strike Force model. For example, OIG refers credible allegations of fraud to the Centers for Medicare & Medicaid Services (CMS) so that it can suspend payments to the suspected perpetrators, thereby immediately preventing losses from claims submitted by Strike Force targets. Strike Force teams have shut down health care fraud schemes around the country, arrested more than a thousand criminals, and recovered millions of taxpayer dollars.

The announcement of the Newark/Philadelphia strike force included some indication of possible areas of focus for the new team.  Assistant Attorney General Benczkowski stated, “The devastation the opioid epidemic is inflicting on communities across the country and here in the Mid-Atlantic region is staggering—and health care fraud has played a role in feeding that epidemic. It is estimated that each year tens of billions of dollars in American taxpayer money are lost to fraud, waste, abuse and improper payments.  According to the CDC, in 2016, more than 40 percent of all U.S. opioid overdose deaths involved a prescription opioid. Our Medicare Fraud Strike Forces, which we have now expanded into Newark and Philadelphia, constitute one of our most important and effective means for containing these threats to the American people.”

The Regional Strike Force will be made up of prosecutors and data analysts with the DOJ’s Health Care Fraud Unit, prosecutors with the U.S. Attorney’s Offices for the District of New Jersey and Eastern District of Pennsylvania, and special agents with the FBI, HHS-OIG, and DEA. In addition, the Regional Strike Force will work closely with other various federal law enforcement agencies, including the U.S. Postal Inspection Service and IRS Criminal Investigation, and State Medicaid Fraud Control Units.  The Strike Force will focus its efforts on aggressively investigating and prosecuting cases involving fraud, waste, and abuse within federal health care programs, and cases involving illegal prescribing and distribution of opioids and other dangerous narcotics.

In June of this year, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III noted the success of the Strike Force model while announcing the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.  Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

Nationwide, the Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the prosecutors in the 10 Medicare Fraud Strike Force locations have charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.