FBI retrains its scrutiny on HME

Sunday, August 31, 2003

WASHINGTON - The FBI appears to be once again turning up the heat on healthcare-related fraud and abuse.

Following the Sept. 11, 2001 bombing of the World Trade Center, the FBI deployed 7,000 of its 12,000 agents to help track down nearly 500,000 leads related the 9/11 attack.

“As those leads were covered and there was no longer a need for agents to be involved in that case, they were moved back to their regular beats,” an FBI source told HME News.

What that means, among other things, is that the FBI has picked up the pace of its crackdowns on HME providers suspected of criminal acts of healthcare fraud (kickbacks to referral sources, routine waiver of copayments, forging or altering medical documents, etc.).

“I can’t give a percentage of how much it has increased, but we’ve seen several come across our desks in the past several months,” said Jeff Baird, a healthcare attorney at Brown & Fortunato in Amarillo, Texas.

For 18 months or so following 9/11 Baird heard nary a word of such goings on.

In a headline-generating April raid, FBI agents descended on several Rotech Healthcare locations and carted away truckloads of files. But there have been a number of similar raids on small HME providers, Baird said.

With increased FBI scrutiny, there are several practices an HME provider should employ, Baird said.

First, be compliant and do everything right. Most criminal cases against HME companies start with a disgruntled employee filing a whistleblower lawsuit.

Second, back up your computer every day and store a copy of your files off-site. If the FBI raids your company and removes a bunch of records, you can plug in a copy and get right back to work.

Third, have a compliance expert come in once a year and conduct a mock audit. Have the expert interview employees, referral sources, check documents, the whole shebang. That would eliminate 95% of a company’s problems.

“The problem is, too many HME companies don’t worry about it until they get hit by an audit,” Baird said. HME