OIG Elaborates on Fraud and Abuse Concerns, Including Prescription Drug Fraud in Miami
Yesterday, Brian Martens, Office of Inspector General, Assistant Special Agent in Charge based in the Miami Region testified before Congress and emphasized how taxpayers can prevent and protect against Medicare fraud.
Mr. Martens first noted that, due to law enforcement efforts last year, the government realized a $8 to $1 return on investment. In other words, they collected eight times what they spent on their budget in connection with recoveries and settlements related to fraud and abuse. Mr. Martens also singled-out Florida and Miami as “ground zero” for healthcare fraud. On this point, he further explained that:
In Florida, we are seeing fraud schemes quickly evolve. As enforcement efforts target certain schemes, new permutations of those schemes arise. Not only are fraud schemes mutating, they are migrating – geographically and even between parts of the Medicare program.
One example of these permutations was in the conduct related to HIV fraud schemes. In Florida and Detroit, they investigated one of the first Medicare B HIV fraud schemes. According to Mr. Martens, however, some of those schemes appear to have migrated to Medicare C managed care plans.
During his testimony, Mr. Martens also highlighted his office’s success in deterring the amount of fraud related to community healthcare centers in Florida and underscored other areas of serious concern including home health agencies in Florida and pharmaceutical fraud. Indeed, Mr. Martens testified that:
Medicare Part D, specifically pharmacy fraud, is an area where we are seeing the largest increase in our South Florida case work. Prescription drug fraud is a complex crime that can involve many co-conspirators – drug distributors and traffickers, health care professionals, patient recruiters, drug-seeking patients, and pharmacies may all play a role. Criminal enterprises are also becoming an increasing presence in prescription drug fraud.
It is important to note that OIG prescription drug fraud cases are not limited to investigating schemes involving only controlled substances. Our work is increasing in matters involving high-cost, non-controlled, name brand prescription drugs such as respiratory, anti-psychotic, and HIV/AIDS medications.
According to Mr. Marten, in the Part D world, OIG’s caseload has also quadrupled in the last five years and, moreover, prescription drug fraud in Miami continues to be a serious concern.
The full transcript of his testimony is available here
Author: Andrew Feldman
Mr. Feldman represents professionals, corporations, health care providers, and health care marketers in government investigations and prosecutions throughout the United States. Mr. Feldman works tirelessly for his clients from the time an investigation begins until the time a jury renders a verdict.
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