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March 3, 2010

DOJ: Collaboration is Key to Combating Healthcare Fraud

This past week at the _ Health Law Section 11th Annual Conference on Emerging Issues in Healthcare Law in Phoenix, top officials from the Obama administration gathered to discuss the latest developments in healthcare fraud and enforcement. With trillions of dollars a year being funneled to healthcare providers for goods and services, Justice Department officials detailed how the industry is ripe with instances of fraud.

Kirk Ogrosky, U.S. Dept. of Justice Medicare Fraud Strike Force

Kirk Ogrosky, U.S. Dept. of Justice Medicare Fraud Strike Force

Speaking to a crowd of record attendance, Kirk Ogrosky from the U.S. Department of Justice Medicare Fraud Strike Force, led the discussion. Additional speakers included Daniel R. Anderson, also from the Justice Department, and Gregory Demske, U.S. Department of Health and Human Services.

Noting that fraud schemes tend to spread across the country like a virus, Ogrosky said that the majority of these schemes happen regionally and that the majority of fraud comes from goods and services relating to Medicare Part D, due to a “low probability of detection.”  In particular, the department has seen a rise in fraud in cities like Miami and Detroit.

In order to better identify and combat fraud, Ogrosky said that the Justice Department has designed comprehensive law enforcement programs with the cooperation of DHHS and the FBI, in order to further early detection through collaboration.

Fraud detection is often a complex process. Working with doctors and nurses, DOJ uses auditors and other evaluators to analyze medical claims data, although Ogrosky noted that “data is just the first part of the story.”

Ogrosky also noted that while the actual dollar amount that is recovered from these fraud cases is very low, the overarching goal for the Justice Department is that of criminal deterrence.

Stating that his office was currently recruiting, Ogrosky encouraged lawyers to join DOJ in its fight, noting that “the more money recovered [and the less fraud] makes the healthcare system more stable for everyone.”

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