D.C. Federal Defense Attorney

Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.

In recent years the government has ramped up enforcement to bring an end to Medicare fraud. The joint DOJ-HHS Fraud Strike Force is comprised of a multi-agency team of federal, state and local investigators. Accordingly, this massive takedown involved the work of approximately 400 law enforcement agents from the FBI, HHS-Office of Insepctor General, and other federal, state and local agencies. In addition to the 91 arrests, the Strike Force also executed 18 search warrants in connection with ongoing investigations. As if this massive takedown wasn’t already enough, the Strike Force arrested an additional 45 defendants the same day in Miami and in the past couple of months has charged 10 defendants in Baton Rouge, 6 defendants in Los Angeles, 18 defendants in Detroit, and 2 defendants in Houston.

This level of coordination is unmatched in other white collar/fraud related crimes. Thus, the government’s stubborn focus on preventing fraud should not be taken lightly by anyone in the healthcare industry. As Assistant Attorney General Breuer said at the press release, “as charged in these indictments, the defendants cover nearly the entire spectrum of healthcare providers, and perpetrated a variety of fraudulent schemes.” Since its inception in 2007, the Strike Force has operations in nine major cities across the nation and has charged more than 1,140 defendants who account for nearly $2.9 billion in false billings.

The best way to avoid being ensnared by a federal investigation is for healthcare providers to maintain aggressive Medicare fraud and abuse compliance programs. These internal corporate policies should, at the very least, be written and cover a wide range of corporate functions susceptible to fraud and abuse. Other critical elements to a successful compliance program include the designation of a compliance officer, conducting effective training and education, developing effective lines of communication, establishing internal enforcement procedures, auditing and monitoring, and maintaining a whistleblower/non-retaliation policy. Preventing all violations may be impossible, but that shouldn’t stop healthcare providers from establishing and faithfully administering an anti-fraud compliance program. With such a program in place, the government will tend to look the other way when technical violations of the law occur. This is a much better, and cheaper, outcome than being charged in a federal indictment.

Since Medicare is a federally funded program most defendants are charged with federal crimes and required to make appearances before a U.S. District Court judge. Indictments in these cases usually include “white collar” charges such as health care fraud, conspiracy to commit health care fraud, receipt of health care kickbacks, and money laundering. In addition, practically all of the defendants are subject to criminal forfeiture proceedings and required to pay restitution if convicted. These charges are very complex, time consuming, and expensive to defend against. Therefore for both compliance and defense purposes, healthcare providers should employ the services of an attorney that has an intimate understanding of the intersection between federal regulatory compliance and federal criminal defense.

The author of this blog is Erich Ferrari, an attorney specializing in Federal Criminal Defense matters. If you have any questions please contact him at 202-280-6370 or ferrari@ferrari-legal.com.