Other Fraud Fighters

SMPs are the grassroots workers in the fight against fraud. Law enforcement entities take it from there—the FBI, CMS, HHS, DOJ, and state attorneys general. “We’re all partners,” said Dieker. “No one of us can do it on our own.”

The government has ramped up its efforts to combat Medicare fraud. In May, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT). They also announced the expansion of Medicare Strike Force team operations to Detroit and Houston; the Strike Force has been operating in South Florida and Los Angeles since 2007, analyzing billing data to search out Medicare fraud at the local level.

In June 2009, one month after the announcement, 53 people were indicted for conspiring to submit more than $50 million in false Medicare claims, according to a Department of Justice press release. The arrests involved at least nine Medicare provider companies and a number of company executives, doctors, therapists, medical assistants, and even some Medicare beneficiaries.