A tip helped break one of the largest health fraud cases ever prosecuted in New Jersey, leading to dozens of convictions over the last several years.
Now, prosecutors are getting another weapon to use that may help them detect similar frauds more quickly.
The U.S. Attorney’s Office and Department of Justice are forming a task force in the New Jersey/Philadelphia area to address health care fraud and its byproduct, opioid abuse. It’s modeled on similar approaches that have been used in cities including Houston, Detroit, Chicago, Miami, Los Angeles and Dallas.
The move comes in the wake of two recent large-scale busts in New Jersey. The operators of a blood lab who orchestrated a long-running, $100 million bribes-for-referrals scheme were sentenced in June in a case that was initiated by a tip from a non-participant. More than 50 people, including more than three dozen doctors, were convicted or pleaded guilty.
Also recently, investigators uncovered a $50 million fraud scheme in which pharmaceutical sales representatives recruited public-sector employees to obtain expensive compound medications that they didn’t need. A pharmacy then paid kickbacks to the conspirators.
The U.S. attorney’s office in New Jersey already is aggressive in going after health care fraud and has recovered more than $1 billion since 2010, according to U.S. Attorney Craig Carpenito.
A key element the Newark/Philadelphia Regional Medicare Fraud Strike Force will add, however, is the sharing of data analytics. Instead of relying on whistleblowers or citizens to come forward, monitoring data on doctors’ reimbursement claims should help investigators detect potential fraud more quickly.
Data that could raise red flags to investigators include a doctor’s office filing a high number of showing a sudden increase of claims involving more expensive compound medications or procedures.
“We investigate the cases that are brought to us,” Carpenito said, adding that nearly all come from whistleblowers. “Hopefully, we will be able to double the impact.”
Since the Justice Department began the task forces in 2007, more than 3,700 people have been charged with more than $14 billion in fraudulent billing, said Brian Benczkowski, Assistant Attorney General of the Justice Department’s Criminal Division.