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  4.  → DOJ announces another regional Medicare Fraud Strike Force

DOJ announces another regional Medicare Fraud Strike Force

The United States Department of Justice (DOJ) has announced another regional Medicare Fraud Strike Force to join the current forces in 10 cities throughout the country. Strike Forces are currently present in Brooklyn, Miami, Los Angeles, Detroit, Houston, Baton Rouge, New Orleans, Tampa, Chicago and Dallas.

The new division will cover the Newark, NJ and Philadelphia, PA areas.

What is the purpose of these strike forces? The DOJ states these Strike Forces focus on “aggressively investigating and prosecuting cases involving fraud, waste, and abuse within our federal health care programs, and cases involving illegal prescribing and distribution of opioids and other dangerous narcotics.”

Are they successful? Yes. With assistance from these Strike Forces, the DOJ recently conducted the largest healthcare fraud takedown in history. In June, the agency charged over 600 individuals for over $2 billion in false billing claims.

Is this different? A recent report by NY Daily News points out this strike force will make use of data analytics sharing. The force will use technology to monitor doctor reimbursement claims and may help investigators detect fraudulent operations more efficiently. The technology will look for red flags like:

  • Changes. A medical office that has a sudden increase in claims filed will likely get red flagged.
  • Medications. Clinics that rely mainly upon the use of expensive medications could become the target of an investigation by the strike force for fraudulent operations.

These advances will not end with the New Jersey force. It is likely other strike forces, like the one in New York, will make similar advances.