Strike Force Operations SA Jeff Richards HHS-OIG’s Strike Force Operations SA Jeff Richards

Strike Force Model The Strike Force is efficient: Expedited Investigative Model Using a Data-Driven Approach Prosecutor Assigned to Each Team Multi-agency > HHS-OIG, FBI, MFCU, DOJ, USAO Non Law Enforcement Partners

The Strike Force Mission To gather resources across the government to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs. To crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year. To reduce health care costs and improve quality of care by preventing fraudsters from preying on people with Medicare and Medicaid.

The Strike Force Mission To highlight best practices by providers and organizations dedicated to ending waste, fraud, and abuse in Medicare and Medicaid. To build upon the existing partnerships between HHS, DOJ and State Partners to reduce fraud and recover taxpayer dollars.

The True Strike Force Mission Improve Efficiency of Prosecutions Speed up the investigative and prosecution process. Target particular provider types or programs that are ripe for fraud.

Where Did it All Begin?

Strike Force Origin 2007 in Miami, FL targeting DME fraud In 2008, given the success in Miami, Strike Force is expanded to Houston and Los Angeles

Strike Force Origin HEAT

HEAT In May 2009, the Department of Health and Human Services (HHS) and Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT). With its creation, the fight against Medicare fraud became a Cabinet-level priority. HEAT’s work was initially directed by HHS Secretary Kathleen Sebelius, but now is under the direction of Secretary Tom Price and US Attorney General Jeff Sessions.

HEAT – Strike Force Origin 2009: The Strike Force becomes a subcomponent of HEAT making it part of a Cabinet Level Initiative. 6 Cities are added Detroit, Tampa, Brooklyn, Dallas, Chicago and Baton Rouge

Strike Force Cities

Strike Force Accomplishments July 2017 Takedown 412 Defendants Charged 115 Medical Professionals $1.3 Billion in Losses 41 Federal Districts 295 Exclusion Notices Total Criminal Actions: 1,791 Indictments: 2,326 $2.5 Billion

South Louisiana Strike Force Accomplishments Totals Since Inception Final Criminal Actions: 95 Individuals Awaiting sentencing: 5 individuals Sentences up to 15 years Unduplicated Restitution totaling approximately $150 million. This is in addition to non Strike Force cases investigated by our office.

Strike Force Accomplishments The Strike Force’s True Success: Being able to adapt the model to different types of fraud rather than just DME Types of Successful Cases Under Strike Force Model HIV Drugs/Infusion, Ambulance/Medical Transport, CMHC, Home Health, Psych Visits, Physician Part B Services, Drug Diversion, Hospice, etc.

The Strike Force Effect

The Strike Force Effect The Strike Force has had a dramatic effect on billing in several areas. Most Notably: DME / Power wheelchairs CMHC

The Strike Force Effect

The Strike Force Effect CMHC Billing in Baton Rouge

The Strike Force Effect CMHC Billing Nationally

What’s Next and Emerging Trends Strike Force What’s Next and Emerging Trends

Emerging Trends Healthcare Fraud: Sophistication of Fraud Schemes White Collar vs Organized Crime Sophistication of Fraud Schemes Home Health Part D/Drug Diversion Labs Hospice Continued Use of Data to Find and Fight Fraud

Report Fraud and Overpayments Hotline: 1-800-HHS-TIPS (1-800-447-8477) https://forms.oig.hhs.gov/hotlineoperations/ Self Disclosure http://oig.hhs.gov/compliance/self-disclosure-info/

Questions? Special Agent Jeff Richards Baton Rouge Field Office US Department of Health and Human Services Office of the Inspector General Office of Investigations Questions?