CHICAGO — The U.S. Attorney's Office for the Northern District of Illinois has launched a new unit aimed at cutting into the billions of dollars lost to health care fraud schemes.
Joel R. Levin, acting U.S. Attorney for the Northern District of Illinois, recently announced that the team will be led by assistant U.S. attorneys Heather McShain and Stephen Chahn Lee and a team of five prosecutors.
The new unit is a symbol of a focus by the U.S. Department of Justice (DOJ) on health care fraud across the country. It came just days after the U.S. Health and Human Services Office of Inspector General announced more than 400 suspects had been rounded up as part of a false billing scheme that had cost the system at least $1.3 billion in fraudulent costs. Over the past decade, the DOJ's Medicare Fraud Strike Force has charged more than 3,500 individuals with allegedly defrauding Medicare for more than $12.5 billion.
“This is a reflection of the national drive by the DOJ to criminalize Medicaid fraud,” Patrick J. Cotter, head of the government interaction and white collar practice group at Greensfelder, Hemker & Gale P.C., told the Cook County Record. “It’s not a new development, but with the new administration has come more of an emphasis on the issue.”
The new team is expected to focus on fraud schemes ranging from providers who engage in fraudulent billing schemes to doctors who may falsify patients’ diagnoses to justify expensive tests, according to a statement by the U.S. Attorney's Office for the Northern District of Illinois.
“A big part of this is aimed at holding down Medicaid and Medicare fraud,” Cotter said. “There’s a lot of money involved and there’s a lot of corruption around it.”
The DOJ’s Chicago office recently took part in the largest health care fraud enforcement undertaking in DOJ history, securing 10 criminal convictions as part of a multi-year investigation into Sacred Heart Hospital in Chicago, where it was uncovered that executives had engaged in a conspiracy of bribing doctors to refer patients for services that would be reimbursed by Medicare and Medicaid.
Among those convicted were the hospital’s chief executive officer, the chief financial officer and at least five physicians. The hospital was forced to cease operations in 2013.
“The stakes are high and the growing trend is to treat more mistakes as crimes,” Cotter said. “Government’s big area of focus seems to be in the areas of billing, record keeping and training. A lot of problems stem from staff not following governmental rules and regulations.”
Cotter advised medical executives to focus on training, "making sure everyone takes information, fills out forms and is well-trained."
“More often than not, the average company runs into trouble with people breaking rules and taking short cuts,” he said.