Thread: Agents Conduct Medical Fraud Raids Across Houston

Agents conduct medical fraud raids across Houston (w/Video)

Warrants served at 12 locations related to 32 indictments

By JAMES PINKERTON Copyright 2009 Houston Chronicle
July 29, 2009, 8:47PM

Teams of federal investigators spread out across Houston early Wednesday arresting dozens of health care operators and providers charged with making $16 million in fraudulent Medicare claims.

Twenty-three people were taken into custody in Houston. Three others were apprehended in separate operations in New York, Boston and Louisiana, authorities said.

The operation by the newly formed Houston Medicare Fraud Task Force underscored U.S. Justice Department warnings that the Houston metropolitan areas has become a major front in the government's battle to clamp down on an estimated $60 billion in fraudulent health care claims each year.

Tim Johnson, the U.S. attorney in Houston, warned other violators that Wednesday's roundup marked the beginning of a lengthy federal investigation that will lead to more arrests in the future.

We hope what we've done today is send out a message to those who might be similarly inclined to violate the health care laws, and put them on notice this is just the first stage of these arrests, Johnson said.

Johnson noted the Houston task force, assembled in May, is using a unique tactic of reviewing real time data of billing claims as they are filed by Medicare providers, determining if they don't smell right, and then opening investigations if warranted. Previously, fraud investigations were driven by complaints from Medicare providers or patients, the veteran prosecutor said.

At one firm, Memorial Medical Supply on Dairy Ashford in West Houston, nearly a dozen agents from the U.S. Department of Health and Human Services Office of Inspector General arrived at 8 a.m. to begin removing box after box of company records. Two women, who identified themselves as company employees, arrived an hour later to assist authorities, but told reporters they could not comment.

Immigrant influx cited

Investigators say one reason Medicare fraud is on the rise in Houston is a steady influx of immigrants who, in some instances, consider gaming the government for benefits an acceptable practice, said one top Justice Department investigator, speaking on condition he would not be identified.

There's a real problem of health care fraud in recent immigrant communities we see it everyday, the official said. One of the reasons is you're looking at people who don't come up through the educational system, they're impoverished, they think this country is very rich, and they don't view taking advantage of a government program as a crime.

The federal charges, outlined in seven indictments returned by a Houston grand jury, allege the Houston health providers filed false claims for so-called arthritis kits a collection of orthopedic braces expensive battery-powered wheelchairs and feeding tube equipment and supplies, according to a Justice Department news release.

From city to city?

In some cases the medical equipment was not medically necessary, was never provided, or claims were filed in the name of patients who were actually deceased, the Justice Department said.

The Justice Department investigator said the Houston fraud claims were similar to other Medicare billing scams uncovered in other cities, an indication that those responsible, or their associates, move from city to city.

The reason we find that certain items, like the arthritis kits or (feeding) tube supplies, tend to be the focus of billing is we're not dealing with health care professionals who are really smart, or are interested in providing health care, he said. What we are dealing with is a group of criminals who have learned how to defraud the system, and have learned it from other criminals.

An examination of billing patterns of Medicare providers show the Houston metropolitan area has grown into the third largest area for health care fraud in the nation, he said. The officials added that fraud indicators in other areas of the federal Southern District, including the Rio Grande Valley, Victoria, and Corpus Christi are through the roof.

Since the first Medicare strike force was created in South Florida in 2007, three others in Los Angeles, Detroit and Houston have been added. In all, the effort has resulted in indictments against more than 293 individuals, or organizations, who together billed Medicare in excess of $674 million, the Justice Department said.

Striking back'

Our Medicare Strike Force is striking back against health care fraud in all its forms and wherever it occurs, said Deputy Attorney General David W. Ogden, in a statement. We will stop fraud as its happening, using real-time data analysis of Medicare billing records.

Investigators said a preliminary review of Medicare claims for feeding tubes in Houston defied reality, noting it appeared that in certain ZIP codes every older person should have a tube in them.

james.pinkerton@chron.com

http://www.chron.com/disp/story.mpl/met ... 52547.html

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