Federal agents are deploying a new level of law enforcement called the regional Medicare Fraud Strike Force. It’s a multiagency team that uses big data to unmask the growing number of health care crooks hiding in plain sight.
“The Strike Force has two purposes. First is to tackle increased waste fraud and abuse within our federal health care programs which caused the cost of Medicare and Medicaid to skyrocket. And secondly, and perhaps more importantly, to address the epidemic of prescription drug overdoses in opioiate involved deaths,” said Brian Benczkowski, assistant attorney general of the Department of Justice’s criminal division.
They’ll do it by teaming up prosecutors and data analysts within the criminal and health care fraud units — New Jersey’s U.S. Attorney’s Office, the FBI, DEA and others. Together, they’ll follow billions of bits of data trails left in Medicare claims and transactions.
“They do nothing else but look at this type of data, identify outliers and learn how to build cases quickly and efficiently and cut the head off the snake, which in this system are the doctors who are pushing opioids out on the street, and just generally bilking the public fisc,” said Sandra Moser, Department of Justice fraud section acting chief.
“If we’re looking at a pharmacy and all the patients that go to these pharmacies are coming from 300 and 400 miles away it tells you that something is wrong,” said Scott Lampert, HHS-OIG special agent in charge. “Everyone has a pharmacy within a mile radius of their house, so the fact that all these people are going to one pharmacy from a long distance tells us that something is wrong — is there a certain drug they’re after? Are they being paid to go there?”
The advanced analytics will allow the strike force to get out in front to investigate, prosecute and ultimately stem fraudulent practices. The model is being used successfully in 10 other cities around the country.
“Since its inception in March of 2007, this task force model has charged over 3,700 defendants nationwide who falsely billed the Medicare program for a total of over $14 billion,” Benczkowski said.
“It beings more physical resources. We’re going to have more prosecutors that we can dedicate to this. It also formalizes the relationship between the fraud section down in Washington D.C. and the District of New Jersey,” said Craig Carpenito, U.S. attorney for the district of New Jersey.
And time, as they say, is of the essence. According to federal reports cited Monday, New Jersey ranks among the top third of all states for opioid-related deaths.
“The opioid and the prescription drug threat and the fraud that goes along with that is a multibillion dollar nationwide threat to everyone, so we want to combine those efforts, focus on that and see if we can mitigate that to the best of our ability,” said Gregory Ehrie, FBI Newark Field Office special agent in charge.
A new level of oversight in a new era of innovation.