Investigators plan to turn up heat in Texas

Saturday, May 31, 2008

DALLAS, Texas--It could get hotter than usual in Texas this summer when the Medicare Fraud Strike Force cranks up the heat. Providers, however, are taking the news in stride

“I say bring it on,” said Sandy Cormier, owner of San Antonio-based Rehab in Motion.

The Strike Force is a collaborative effort between CMS, the Department of Justice, the FBI and local law enforcement agencies. Investigators analyze real-time billing data to identify unusual billing patterns.

Texas is the third state targeted by the Strike Force, which launched in south Florida in May 2007 and moved to Los Angeles this March.

“Historically, those are the three areas that have a lot of Medicare fraud,” said Cormier. “That kind of paints us all with a bad brush.”

Long-time providers in Texas remember Operation Wheeler Dealer, a three-year investigation into fraudulent power wheelchair claims that launched in 2002.

“It was a big, big deal,” said Mike Pitifer, owner of Ace Medical Equipment in Lubbock. “I think that is where the investigation issues have come from.”

Provider Larry Rice also remembers those dark days. He applauds weeding out the bad apples, but doesn’t want this latest initiative to turn into a “witch hunt.”

“Industry fraud reflects poorly on me and my staff,” said Rice, president of Dallas-based In Home Products. “But it hurts my patients if they come after us and disrupt our service.”

Providers feel that the Strike Force is one more example of Medicare acting after the fact.

“Why do they let it go so long before they decide we have a problem?” asked Michael Flores, a partner at San Antonio-based Huntleigh Home Medical. “If there’s a substantial change in reimbursement from one month to the next, wouldn’t that send up a red flag?”

To date, the Strike Force has uncovered $420 million in fraudulent claims and indicted 130 individuals in 76 cases in the Miami-Dade County area.

Since March, the Strike Force has brought charges against 11 individuals with a collective $13 million in fraudulent claims.