Home Health & Hospice Week

Fla., or Baton Rouge, La., get ready for some major scrutiny.

The Departments of Justice and Health and Human Services are expanding the Medicare Fraud Strike Force program to those three areas, DOJ and HHS say in a release. The strike forces, run under the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, already operate in South Florida, Los Angeles, Detroit, and Houston.

"When President Obama took office, he promised a new commitment to cracking down on the criminals who steal billions of dollars from Medicare each year through fraudulent claims," HHS Secretary Kathleen Sebelius says in an HHS release. "Today, HHS and DOJ are following through on that commitment."

HEAT's enforcement is no joke. The Florida strike force recently secured indictments against 15 Miami area residents, including a physician and six RNs, for Medicare fraud related to excessive outlier billing for home health agencies.

In the alleged scam, Dr. Fred Dweck referred nearly 1,300 patients for unnecessary home care visits supposedly due to their blind diabetic status, among other reasons. The two owners of the medical clinic where Dweck worked, Arturo Fonseca and Yudel Cayro, allegedly accepted kickbacks and bribes for having Dweck sign documentation for some of those patients.

Recruiters also received kickbacks and bribes for recruiting the patients, and nurses and aides falsified records to make it appear that patients were eligible for services when they weren't, prosecutors say in a release from the Federal Bureau of Investigation.

At the same time, fraud charges were brought against a durable medical equipment supplier in New York for providing unnecessary diabetic shoe inserts; an infusion clinic in Miami for billing for services that were medically unnecessary or never provided; and participants in a Detroit-area medical clinic scam. Fraudulent billing from all the schemes came to $61 million, HHS says in a release.

"The HEAT operation today in Miami demonstrates the continued success of our interagency South Florida Strike Force team and is clear evidence of our resolve to investigate and stop schemes that abuse federal health care programs at the expense of taxpayers and vulnerable recipients," said Christopher B. Dennis, Special Agent in Charge of the HHS Office of Inspector General Miami Region.

"It is ... disheartening when so many individuals in the medical care system, from doctors and nurses down to beneficiaries, participate in these schemes," John V. Gillies, Special Agent in Charge for the FBI's Miami Field Office, says in the release. "The FBI and our law enforcement partners will continue to aggressively investigate these alleged fraud schemes and the medical care professionals who abuse their positions of trust for personal gain." Since the Strike Force program began in March 2007, it has obtained indictments of more than 460 individuals and organizations that have falsely billed the Medicare program for more than $1 billion, HHS notes.