Last year, David Hickton, U.S. Attorney for the District of Western Pennsylvania, requested agents from the Department of Health and Human Services (HHS) Office of Inspector General to help root out healthcare fraud that was becoming more prevalent in the region. They never showed, so this year he decided to take matters into his own hands by creating a homegrown fraud task force, according to the Pittsburgh Post-Gazette.
After seeing the impact that the Medicare Strike Force has made in other regions of the country, like Detroit and Miami, Hickton tells the newspaper that beginning Oct.1, his office is partnering with regional FBI agents to identify healthcare fraud schemes. Last year, Hickton assigned top prosecutors to investigate healthcare fraud in Western Pennsylvania, which has led to nine cases ranging from drug diversion schemes to bogus medical clinics, according to another article from the Post-Gazette.
The new task force will also use investigators from the Drug Enforcement Agency, Food and Drug Administration, the U.S. Postal Service, and the IRS, with help from providers such as the University of Pittsburgh Medical Center and Highmark that can provide suspicious claims. However, some legal experts say that without HHS agents who have easy access to payment information, a homegrown strike force may not make the same impact as those established in larger cities.
Medicare Fraud Strike Force teams, which have been rolled out in nine areas of the country with a high prevalence of healthcare fraud, have been instrumental in some of the larger fraud busts, including the historic 243-person fraud takedown in June. An inside look at the strike force operations shows a team similar to a "major narcotics operation," FierceHealthPayer: Antifraud previously reported. As evidenced by recent enforcement actions, the agencies within the strike force have become more effective by nurturing partnerships with state attorney general offices.
Distinct enforcement trends emerge following the largest fraud takedown in history
Historic Medicare fraud takedown: Feds charge 243 people with $712M in false billing
An inside peek at the Medicare Strike Force