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Healthcare Fraud

Healthcare Fraud. David Burris Senior Director Alvarez & Marsal Dispute Analysis & Forensic Services Washington DC/Tampa FL. Alvarez & Marsal. 1,700 professionals in the US and 16 countries Restructuring and Turnaround Healthcare Tax Real Estate Public Sector Transaction Advisory.

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Healthcare Fraud

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  1. Healthcare Fraud David Burris Senior Director Alvarez & Marsal Dispute Analysis & Forensic Services Washington DC/Tampa FL 21st Annual ECI Conference

  2. 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

  3. 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

  4. 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

  5. HHS-OIG SAR • Omnicare/IVAX - $112 million – kickbacks • MylanPharma/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

  6. HHS-OIG SAR • Pfizer - $1.3 billion fine & forfeitures • Marketing and promotion practices - Bextra • Off-label marketing 21st Annual ECI Conference

  7. 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

  8. 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

  9. Operation Hardgear 21st Annual ECI Conference

  10. Operation Hardgear 21st Annual ECI Conference

  11. Operation Hardgear 21st Annual ECI Conference

  12. Operation Hardgear 21st Annual ECI Conference

  13. 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

  14. David Burris, Senior Director Alvarez & Marsal 2001 K Street NW, Suite 803 Washington, DC 20006 (202) 729-2128 (office) (202) 368-7113 (cell) dburris@alvarezandmarsal.com 21st Annual ECI Conference

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