Medicare Anti-Fraud Program Expands Footprint in Two States

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By James Swann

An interagency Medicare anti-fraud program has expanded in southern Texas and Louisiana, allowing investigations to move outside a limited geographic area and cover more providers.

The Medicare Fraud Strike Force expansions were never formally announced and have been in place for more than a year. The Baton Rouge Strike Force was renamed the Southern Louisiana Strike Force, encompassing New Orleans in addition to Baton Rouge, while the Houston Strike Force was renamed the Southern Texas Strike Force, covering territory all the way south to McAllen, Texas, along the border with Mexico.

Gejaa Gobena, a health-care attorney with Hogan Lovells in Washington and former deputy chief of the fraud section in the Department of Justice’s Criminal Division, told Bloomberg BNA March 9 that he oversaw both expansions during his time at the DOJ.

The Louisiana expansion happened when investigators noticed the fraud schemes they were looking at involved conduct both in Baton Rouge and New Orleans, Gobena said, and it made sense to bring some cases in New Orleans.

“Also, many fraudsters who had moved themselves and their schemes to Baton Rouge after Hurricane Katrina started to move back around 2012-2013,” Gobena said.

As for the Houston expansion, Gobena said he saw data showing health-care fraud in McAllen, which is in the same judicial district as Houston. This led to the expansion into the Southern District of Texas to take on the new fraud cases, Gobena said.

“I had secured funding for over 20 more prosecutors before the expansions, so there were extra prosecutors to handle cases in the new areas as well as to fuel the Criminal Division’s push into corporate health-care fraud cases,” Gobena said.

Not a Trend?

Gobena said he didn’t foresee similar expansions of existing Strike Force cities, noting the unique circumstances in both areas that drove the expansions.

“I can see them analyzing the data, though, to see whether they should shut down Strike Force in certain venues and go into other cities and regions,” Gobena said.

The Medicare Fraud Strike Force program was created in 2007 and includes representatives from the Health and Human Services Office of Inspector General, the Department of Justice and local law enforcement agencies. It operates in Chicago, Dallas, Miami, Los Angeles, Detroit, Brooklyn, N.Y., and Tampa, Fla., in addition to the Southern Texas and Louisiana regions.

Fraud Recognition

The renamed Strike Forces may not represent new strategic thinking as much as a clarification about what is actually going on in the regions, Richard Westling, an attorney with Waller Lansden Dortch & Davis LLP in Nashville, Tenn., told Bloomberg BNA March 9.

Expanded investigations were happening well before the two Strike Forces were renamed, Westling said.

“Based on my experience as the first assistant U.S. Attorney in New Orleans, I can say that the Baton Rouge Strike Force has been handling cases in New Orleans since sometime before 2014,” Westling said.

Westling said the renaming may have been intended to provide a better description of the scope of work.

“What may be new, and could extend to other Strike Forces, is the recognition that cases are emerging in other cities that are geographically close enough to the original Strike Force cities that the same team of attorneys can prosecute those cases,” Westling said.

Westling said the renamed Strike Forces also highlight that health-care fraud schemes tend to exist regionally, rather than in a specific city.

The DOJ recently began recruiting some Strike Force attorneys who live in or near a Strike Force city, and the expansions may help ensure a steady flow of cases to keep the attorneys busy, Westling said.

To contact the reporter on this story: James Swann in Washington at jswann1@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

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