U.S. attorneys turn up heat on healthcare fraud

The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight healthcare fraud.

U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases.

"My advice to the medical community is to stay away from gray areas or outright fraud that wastes tax dollars, because we will be watching," Johnson told the Sioux Falls Argus Leader. "The end result in many of these cases will be that the taxpayers get their money back with interest and penalties, and the medical professional loses their license."

Johnson's office recently settled an alleged fraud case involving two doctors at Dakotas-based Sanford Health. Court documents show that Sanford paid $625,000 to settle the lawsuit, in which the doctors and the hospital did not admit wrongdoing. Cindy Morrison, Sanford's executive vice president for marketing and public policy, said the hospital settled to avoid distraction.

"For us, it's the issue of time and expense," she said.

In the Sanford case, a whistleblower accused the doctors of defrauding federal health care programs. A person who has knowledge of fraud can sue on behalf of the federal government to recover money under the Federal False Claims Act, said Monica Navarro, a professor at Thomas M. Cooley Law School in Michigan and an expert in so-called "qui tam" lawsuits.

The government in the Sanford case alleged almost $375,000 in damages to Medicare, Medicaid and Veterans Affairs from May 2010 to April 2011, Johnson said. The damages were multiplied by 1.66, and Medicare received most of the damages, more than $432,000.

U.S. Attorney Timothy Purdon of North Dakota said his office has added a special prosecutor — in concert with HHS — who works specifically on cases involving doctors and others who work with Fargo-based Noridian Healthcare Solutions. Noridian handles Medicare claims for many states.

Purdon's office recently prosecuted a case involving a Seattle doctor accused of turning in phony Medicare claims that included reports of nursing home visits to patients who were dead.

U.S. District Judge Ralph Erickson earlier this month sentenced John C. Chen to one year of probation and ordered him to pay restitution of more than $56,600 to the Centers for Medicare and Medicaid Services, which he satisfied as part of $150,000 civil settlement in Washington state.

"This has been a successful program for us in the last couple of years," Purdon told The Associated Press. "It has given us resources as a small district that we wouldn't have to battle this issue."



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