21st Annual ECI Conference

Healthcare Fraud

David BurrisSenior DirectorAlvarez & Marsal Dispute Analysis & Forensic ServicesWashington DC/Tampa FL

21st Annual ECI Conference

Alvarez & Marsal

• 1,700 professionals in the US and 16 countries

• Restructuring and Turnaround• Healthcare• Tax• Real Estate• Public Sector• Transaction Advisory

21st Annual ECI Conference

HHS-OIG SAR

• October 1, 2009 – March 31, 2010• Recoveries - $3.1 billion• Exclusions – 1,935 individuals and entities• Criminal Actions – 293 individuals and entities• Medicare Fraud Strike Forces (HEAT)– Miami - Houston

- Tampa– Los Angeles - Brooklyn– Detroit - Baton Rouge

21st Annual ECI Conference

HHS-OIG SAR

• Medicare Fraud Strike Forces/Health Care Fraud Prevention and Enforcement Action Teams (HEAT)

– Miami - Houston- Tampa

– Los Angeles - Brooklyn– Detroit - Baton Rouge

21st Annual ECI Conference

HHS-OIG SAR

• Omnicare/IVAX - $112 million – kickbacks• Mylan Pharma/UDL Labs - $118 million – false

claims/rebates• Caridad Perez – infusion therapy – patient

kickbacks – 78 months prison, $14 million restitution

• Small Smiles – pediatric dental - $24 million – not medically necessary

21st Annual ECI Conference

HHS-OIG SAR

• Pfizer - $1.3 billion fine & forfeitures• Marketing and promotion practices - Bextra• Off-label marketing

21st Annual ECI Conference

Case Examples

• Investigating agent’s perspective• IRS-CI Special Agent – Healthcare Fraud Task

Force• Types of Investigations– Kickbacks– False Claims– Money Laundering

21st Annual ECI Conference

Operation Hardgear

• Durable Medical Equipment– Motorized wheelchairs– Alternating pressure mattresses– Related items

• Indictments– Conspiracy to defraud Medicare and Medicaid– Health care fraud– Obstruction of justice– Laundering the proceeds

21st Annual ECI Conference

Operation Hardgear

21st Annual ECI Conference

Operation Hardgear

21st Annual ECI Conference

Operation Hardgear

21st Annual ECI Conference

Operation Hardgear

21st Annual ECI Conference

Operation Hardgear

• Convictions– 13 individuals– 11 corporations

• Haught sentence– 7 years in prison– 3 years supervised release– $14,445,429 restitution– $14,845,208 order of forfeiture

21st Annual ECI Conference

David Burris, Senior Director

Alvarez & Marsal2001 K Street NW, Suite 803Washington, DC 20006(202) 729-2128 (office)(202) 368-7113 (cell)dburris@alvarezandmarsal.com