AARP Bulletin: Fighting Medicare Fraud on the Front Lines
The November issue of AARP’s Bulletin carries a special Medicare cover story, “Inside the Medicare Strike Force” by Rick Schmitt. The article details recent successes by a Justice Department unit formed in 2007:
“The strike force has grown from a single outpost in Miami in 200 to nine cities, with the support of 40 of the 100 attorneys in the fraud section of the Justice Department. . . . Just this September, some 280 prosecutors and agents from around the country attended a Justice Department workshop in Washington, D.C., to learn the finer points of investigating and prosecuting Medicare cases. Increasingly, the crackdown has the look of a major narcotics operation, complete with electronic surveillance and frequent use of informants and cooperating witnesses. Defendants’ assets are now routinely seized before trial. Sentences are being measured in decades; even some older beneficiaries are being prosecuted. Agents are backed by forensic accountaints, health care professionals and data acquisition analysts who have a pipeline to Medicare contractors’ billing information.”
A side bar to the main feature focuses on Peggy Sposato, describing her as a “fraudster’s worst enemy,” through use of her data analysis skills to create systematic review of billing records. Her methods successfully trace unlawful Medicare payments. Her career as a fraud buster “began in the mid-1990s after a career as a geriatric nurse.”