Healthcare Fraud David Burris Senior Director Alvarez & Marsal Dispute Analysis & Forensic Services Washington DC/Tampa FL 21st Annual ECI Conference.

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Presentation transcript:

Healthcare Fraud David Burris Senior Director Alvarez & Marsal Dispute Analysis & Forensic Services Washington DC/Tampa FL 21st Annual ECI Conference

Alvarez & Marsal 1,700 professionals in the US and 16 countries Restructuring and Turnaround Healthcare Tax Real Estate Public Sector Transaction Advisory 21st Annual ECI Conference

HHS-OIG SAR October 1, 2009 – March 31, 2010 Recoveries - $3.1 billion Exclusions – 1,935 individuals and entities Criminal Actions – 293 individuals and entities Medicare Fraud Strike Forces (HEAT) – Miami- Houston- Tampa – Los Angeles- Brooklyn – Detroit- Baton Rouge 21st Annual ECI Conference

HHS-OIG SAR Medicare Fraud Strike Forces/Health Care Fraud Prevention and Enforcement Action Teams (HEAT) – Miami- Houston- Tampa – Los Angeles- Brooklyn – Detroit- Baton Rouge 21st Annual ECI Conference

HHS-OIG SAR Omnicare/IVAX - $112 million – kickbacks Mylan Pharma/UDL Labs - $118 million – false claims/rebates Caridad Perez – infusion therapy – patient kickbacks – 78 months prison, $14 million restitution Small Smiles – pediatric dental - $24 million – not medically necessary 21st Annual ECI Conference

HHS-OIG SAR Pfizer - $1.3 billion fine & forfeitures Marketing and promotion practices - Bextra Off-label marketing 21st Annual ECI Conference

Case Examples Investigating agent’s perspective IRS-CI Special Agent – Healthcare Fraud Task Force Types of Investigations – Kickbacks – False Claims – Money Laundering 21st Annual ECI Conference

Operation Hardgear Durable Medical Equipment – Motorized wheelchairs – Alternating pressure mattresses – Related items Indictments – Conspiracy to defraud Medicare and Medicaid – Health care fraud – Obstruction of justice – Laundering the proceeds 21st Annual ECI Conference

Operation Hardgear 21st Annual ECI Conference

Operation Hardgear 21st Annual ECI Conference

Operation Hardgear 21st Annual ECI Conference

Operation Hardgear 21st Annual ECI Conference

Operation Hardgear Convictions – 13 individuals – 11 corporations Haught sentence – 7 years in prison – 3 years supervised release – $14,445,429 restitution – $14,845,208 order of forfeiture 21st Annual ECI Conference

David Burris, Senior Director Alvarez & Marsal 2001 K Street NW, Suite 803 Washington, DC (202) (office) (202) (cell) 21st Annual ECI Conference