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Published bySydney Atkinson Modified over 9 years ago
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Healthcare Fraud David Burris Senior Director Alvarez & Marsal Dispute Analysis & Forensic Services Washington DC/Tampa FL 21st Annual ECI Conference
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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
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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
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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
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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
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HHS-OIG SAR Pfizer - $1.3 billion fine & forfeitures Marketing and promotion practices - Bextra Off-label marketing 21st Annual ECI Conference
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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
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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
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Operation Hardgear 21st Annual ECI Conference
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Operation Hardgear 21st Annual ECI Conference
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Operation Hardgear 21st Annual ECI Conference
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Operation Hardgear 21st Annual ECI Conference
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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
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David Burris, Senior Director Alvarez & Marsal 2001 K Street NW, Suite 803 Washington, DC 20006 (202) 729-2128 (office) (202) 368-7113 (cell) dburris@alvarezandmarsal.com 21st Annual ECI Conference
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