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How the federal government fights health care fraud

When you mess with government money, the government messes with you. That's not a slogan for a fraud awareness campaign ad. The statement is true -- federal investigators have every reason to try to recover money stolen from health care programs funded by taxpayers.

The U.S. government is so serious about health care fraud that two agencies combined forces to combat it. The Department of Justice and the Department of Health and Human Services work together using a single team of enforcers, known as the Health Care Fraud Prevention and Enforcement Action Team. The Medicare Fraud Strike Force has offices in nine cities nationwide, including Baton Rouge.

HEAT was behind charges filed against over 1,400 people, allegedly involved in Medicare fraud schemes since 2007. The strike force claimed those defendants were responsible for $4.8 billion in fraudulent Medicare claims. Reports did not mention how many of those defendants were convicted.

Government officials noted health care fraud charges soared 75 percent from 2008 to 2011, due to actions by the Medicare Fraud Strike Force. HEAT's biggest prize was uncovering a record-setting $530 million health care billing scheme in 2011. The joint effort, using data analysis, is supported by investigators at state and local levels, as part of a "community policing" effort.

The statistics show the federal government makes fraud prosecution a high priority. The numbers also indicate nothing is spared to supply resources for these top-down investigations. Defendants are wise not to dismiss the expertise of federal prosecutors or the considerable funds and investigative people power available to them.

At the same time, keep in mind number analysts and law enforcers make mistakes. Interpretations of data can be wrong. Schemes can be run around innocent parties, who are swept up unfairly in fraud dragnets.

Criminal defense attorneys assert the individual rights of defendants. Strategies to win your freedom are based on your best legal interests.

Source: U.S. Department of Health & Human Services, "HEAT Task Force" Jan. 08, 2015

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