Evan H. Krinick, managing partner, Rivkin Radler
It has been over a decade since the U.S. Departments of Justice and Health and Human Services (HHS) jointly created the federal government’s first Medicare Fraud Strike Force (MFSF) in South Florida. Their goal was to reduce and prevent Medicare and Medicaid fraud through enhanced interagency cooperation. Since then, the program has grown to 15 strike forces operating in 24 federal districts, including in Brooklyn and, since August 2018, in the Newark-Philadelphia region, which in particular has been tasked with targeting health care fraud and illegal opioid prescriptions.
The strike forces focus on the worst health care offenders, in the highest intensity regions, using data analytical techniques to identify abnormal billing levels in health care fraud “hot spots,” that is, in cities with unusually high levels of billing and other fraud. They target suspicious billing patterns as well as emerging schemes and schemes that migrate from one community to another.
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