Fighting Health Care Fraud: State, Federal Governments Amp Up Enforcement Efforts

By Wilkerson, April | THE JOURNAL RECORD, March 2, 2011 | Go to article overview

Fighting Health Care Fraud: State, Federal Governments Amp Up Enforcement Efforts


Wilkerson, April, THE JOURNAL RECORD


The case of the United States of America vs. Lance E. Faulkner, the owner of a Shawnee prosthetic limbs company, shines a light on the government's seriousness toward health care fraud.

The indictment alleges that Faulkner fraudulently obtained more than $5.5 million from Medicare and Medicaid. He faces up to 10 years in prison, a $250,000 fine and mandatory restitution, if convicted. The case is set for trial.

Health care fraud is a massive problem in the United States, but the government is fighting back. Last year's $4 billion recovered from health care schemes was a record amount, as was the 111 nationwide indictments announced earlier this month.

Oklahoma is a part of that battle - a number of federal and state partners tackle the problem every day, going after the bad characters who often give a bad name to those who are following the law.

"I'm very encouraged to think that the steps the federal and state governments are collectively taking to address this problem will be increasingly successful," said Greg Metcalfe, director of the Patient Abuse and Medicaid Fraud Control Unit at the Oklahoma Attorney General's Office. "But we also see that as the federal and state governments invest more money into the Medicaid program, that the creativity and the schemes the untoward come up with continue to increase and amaze."

In calendar year 2010, Oklahoma's Medicaid Fraud Control Unit recouped $5.7 million, Metcalfe said. In the first two months of 2011, it has already recovered $5.2 million. The cases tend to come in waves, he said, but each year has seen more money recovered than the previous year.

At the U.S. Attorney's office for the Western District in Oklahoma City, nearly $4.4 million has been recovered in health care fraud civil and criminal cases since the beginning of fiscal year 2009. That's not counting cases that have resulted in payment plans.

Figures in U.S. Attorneys' Northern and Eastern Districts (Tulsa and Muskogee) tell similar stories. Of the nearly $17 million collected in fiscal year 2010 in the Northern District, health care fraud accounted for $13,229,348 of the civil collections. Over the last 12 months in the Eastern District, $298,313.83 has been recovered in health care fraud cases.

Money recovered in Oklahoma by the U.S. Department of Health and Human Services increases the tally. Winston Whittington, assistant special agent in charge for the Dallas region (which includes Oklahoma), said $18.8 million has been recovered since January 2008 in Oklahoma. Those recouped Medicare and Medicaid dollars come from both civil and criminal penalties and some administrative penalties, he said.

Whittington said the administration's crackdown on health care fraud has meant new investigators for his region, which encompasses Oklahoma, Texas, Arkansas, Louisiana and New Mexico. That means Oklahoma's investigators can spend more time here and less time traveling, he said.

"We've been able to open more cases, which has led to more indictments, more convictions and more civil recoveries," Whittington said.

Sanford C. Coats, U.S. attorney for Oklahoma's Western District, said a robust health care fraud task force has been key in tackling fraud through its sharing of information. That group includes several partners, such as the Federal Bureau of Investigation, the Department of Health and Human Services and the Drug Enforcement Administration.

One of their main tools is the well-known False Claims Act, a Civil War-era rule that is still powerful today. The act allows people not affiliated with the government - the qui tam relators - to bring actions against federal contractors they accuse of committing fraud. It also allows for stiff penalties.

"We can often seek three times the amount the damages that are proved," Coats said. "It's a big deterrent, obviously. We also can, and often do, seek penalties per claim. …

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