Health Care and Law

The HEAT is on: Battling health care fraud

September 30, 2015
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A Detroit oncologist made headlines when his diagnosis and treatment of cancer patients was brought to question. The problem? In many instances, the patients were intentionally misdiagnosed and consequently underwent chemotherapy treatments they didn't need.

Beyond the understandable emotional distress an improper diagnosis can place on an individual and their family, the erroneously filed claims and payment sought from Medicare and Medicaid also wreaked havoc on your finances and mine. Fortunately, the federal government has grown wise to some of these abuses and is coming after doctors — like Dr. Farid Fata of Michigan Hematology Oncology Centers across the metro Detroit area — who bill for treatments that are not medically needed. Such enforcement against medical wrongdoing has been introduced in the form of HEAT, or the Health Care Fraud Prevention and Enforcement Action Team.

Established in 2009, HEAT brings together attorneys and investigators from the U.S. Department of Justice and Department of Health and Human Services to fight Medicare and Medicaid fraud. In nine metropolitan areas, including Detroit, HEAT’s Medicare Fraud Strike Force is investigating fraud cases and bringing offenders to justice.

Prosecuting such cases is difficult and often doesn't happen without the assistance of people from the inside — former and/or current employees of health care providers who can no longer stomach billing for services that are never provided or performed without need. Inside informers, commonly referred to as whistleblowers, provide the documentation that serves as the basis of the prosecution. These cases, however, are not possible without federal laws that provide protection for whistleblowers. Unlike most court cases where the records are available for public inspection, whistleblower cases are sealed by the U.S. District Court to allow the government adequate time to review and investigate fraud allegations. An employee cannot be retaliated against under the False Claims Act, which can result in the employee being reinstated to his or her job in addition to double the lost pay and benefits.

While the case of Dr. Fata has grabbed headlines, the fraudulent activity is often times subtler — taking form in the practice of up-coding. Medical up-coding occurs when a patient seeks medical help for a specific reason — anywhere from a cold to a sprain — and the doctor bills for a longer period of time or for additional treatment than what actually took place.

While too many health care fraud cases in this country still go without persecution, the work of HEAT is making a difference. Because of the strike force’s enforcement efforts, more than 1,400 people have been prosecuted for Medicare fraud, totaling more than $4.8 billion since 2007 — including a one-time case in 2011 where $530 million in fraud was reported. Anyone suspecting Medicare fraud — whether at a doctor’s office, in a home health care setting or at a hospital — should not hesitate to contact an attorney experienced in dealing with such cases. Prosecution of these cases can and will benefit us all.

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