Thursday, April 26, 2018
Opinion

U.S. attorneys rooting out medical fraud in Florida

In a recent opinion piece in the Tampa Bay Times, U.S. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius emphasized the national importance of the campaign against health care fraud that is under way. Their opinion piece highlighted a significant local criminal health care case prosecuted by our office, which is only one of many such prosecutions that we are currently pursuing all over our district.

In addition to criminal prosecutions, we wanted to highlight our robust civil health care fraud practice, which has long been a priority area of practice of our office. While this public issue is still fresh in the minds of Tampa Bay Times readers, I would like to describe our civil fraud enforcement program, and to assure residents in our district that we are aggressively seeking to protect the Medicare trust fund in a variety of ways in this area.

A bit of background: The U.S. Attorney's Office in the Middle District of Florida is one of 94 judicial districts around the country. We serve the nation's second-largest population base (only the Central District of California, which serves the greater Los Angeles area, is larger). We are also home to a very large Medicare population. Our Civil Division serves this unique and sizable population with 23 civil assistant U.S. attorneys in five offices spread all over the state.

Our district has historically had one of the busiest and most productive civil divisions of any judicial district in the United States. One area of explosive growth in recent years is our civil fraud enforcement area. As Holder and Sebelius made clear in their article, fraud against public programs is on the rise nationally, and that trend is certainly reflected in our district.

The nation as a whole has seen a dramatic rise in the number of whistleblower cases (called "qui tam" cases) filed in federal court under the False Claims Act, and in recoveries in those cases. Here locally, according to Department of Justice statistics, the Middle District of Florida has ranked among the top 10 busiest district in terms of new qui tam filings for the past five years. Recent years have accelerated the level of growth in both the number of cases we handle each year, and in our recoveries.

In fiscal year 2011, our civil division recovered and returned to the Treasury more than $172 million as a result of settlements in our qui tam cases. Most notable among these was our $150 million settlement with Novartis Corp. in an off-label marketing case involving a number of medications, including Trileptal. We also settled a nationwide kickback case with Ameritox, LLC, a Texas drug testing laboratory, for $16.2 million.

In fiscal year 2012, we concluded our settlement of a series of civil cases against a local Medicare Part C insurer, Wellcare Health Plans, Inc., for $137 million. We also concluded litigation with a national defense contractor, Kaman Dayron, in a defense contract fraud case, in a settlement that paid our military clients $4.75 million.

This past December, we settled alleged fraud claims against Morton Plant Hospital and several affiliated hospitals, arising out of in-patient claims for interventional cardiac services, for $10.1 million.

This month, we reached what the Department of Justice believes to be the largest settlement with an individual physician in the history of the False Claims Act. After years of litigation, a local dermatologist, Steven Wasserman, has agreed to pay $26.1 million to resolve kickback claims and other upcoding allegations.

While most of these cases are settled prior to litigation, we have not hesitated to enter into active civil litigation in our fraud docket and are currently intervened in these cases at record levels all over the district. We have every reason to believe that the level of activity in both settlements and litigation will continue to grow. For that reason I have reallocated resources from within the office to add attorneys assigned to the civil fraud docket, and several seasoned criminal prosecutors have joined our civil division to work on our qui tam docket full time.

The Middle District of Florida believes civil fraud enforcement is critical to the public interest. It is a challenging arena, there is an enormous amount of public money at stake, and in many cases there is a substantial potential for patient harm embedded in the schemes that concern us. Using both civil and criminal remedies for this kind of misconduct, we will continue our long-standing commitment to our district's residents to protect their programs and patients' interests.

Robert E. O'Neill is the U.S. attorney for the Middle District of Florida.

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