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21st Annual ECI Conference
Healthcare Fraud
David BurrisSenior DirectorAlvarez & Marsal Dispute Analysis & Forensic ServicesWashington DC/Tampa FL
21st Annual ECI Conference
Alvarez & Marsal
• 1,700 professionals in the US and 16 countries
• Restructuring and Turnaround• Healthcare• Tax• Real Estate• Public Sector• Transaction Advisory
21st Annual ECI Conference
HHS-OIG SAR
• October 1, 2009 – March 31, 2010• Recoveries - $3.1 billion• Exclusions – 1,935 individuals and entities• Criminal Actions – 293 individuals and entities• Medicare Fraud Strike Forces (HEAT)– Miami - Houston
- Tampa– Los Angeles - Brooklyn– Detroit - Baton Rouge
21st Annual ECI Conference
HHS-OIG SAR
• Medicare Fraud Strike Forces/Health Care Fraud Prevention and Enforcement Action Teams (HEAT)
– Miami - Houston- Tampa
– Los Angeles - Brooklyn– Detroit - Baton Rouge
21st Annual ECI Conference
HHS-OIG SAR
• Omnicare/IVAX - $112 million – kickbacks• Mylan Pharma/UDL Labs - $118 million – false
claims/rebates• Caridad Perez – infusion therapy – patient
kickbacks – 78 months prison, $14 million restitution
• Small Smiles – pediatric dental - $24 million – not medically necessary
21st Annual ECI Conference
HHS-OIG SAR
• Pfizer - $1.3 billion fine & forfeitures• Marketing and promotion practices - Bextra• Off-label marketing
21st Annual ECI Conference
Case Examples
• Investigating agent’s perspective• IRS-CI Special Agent – Healthcare Fraud Task
Force• Types of Investigations– Kickbacks– False Claims– Money Laundering
21st Annual ECI Conference
Operation Hardgear
• Durable Medical Equipment– Motorized wheelchairs– Alternating pressure mattresses– Related items
• Indictments– Conspiracy to defraud Medicare and Medicaid– Health care fraud– Obstruction of justice– Laundering the proceeds
21st Annual ECI Conference
Operation Hardgear
• Convictions– 13 individuals– 11 corporations
• Haught sentence– 7 years in prison– 3 years supervised release– $14,445,429 restitution– $14,845,208 order of forfeiture
21st Annual ECI Conference
David Burris, Senior Director
Alvarez & Marsal2001 K Street NW, Suite 803Washington, DC 20006(202) 729-2128 (office)(202) 368-7113 (cell)[email protected]