Look out, healthcare fraudsters in New Jersey: Federal prosecutors are coming for you, and they’re bringing algorithms.

The U.S. Justice Department in Washington announced Monday that it is sending two prosecutors and a supervisor to work in conjunction with federal prosecutors in Newark and Philadelphia on tackling fraud and abuse in the Medicare system.

Assistant U.S. Attorney Brian Benczkowski said the strike force concept is being brought to New Jersey in part to tackle Medicare waste, fraud and abuse in a state that is home to many health care companies.

“And second and perhaps more importantly to address the epidemic of prescription drug overdoses and opioid-involved deaths ravaging communities across our country, including here in New Jersey,” Benczkowski said.

“If we can reduce the flow of prescription opioids, we can protect scarce taxpayers dollars while seeking to prevent the next generation of addicts,” he said.

U.S. Attorney Craig Carpenito said his office’s current staff of 18 lawyers who work working on health care investigations in New Jersey will increase by two prosecutors and a supervisor from Washington.

 

A data analytics team in D.C. will also examine prescribing and billing data to identify potential fraud and abuse.

“It’s going to allow us to do the job we were doing better. We’re going to have faster response times to be able to do better investigations, more quickly, more thoroughly. We just have more resources to dedicate to the cause,” Carpenito said.

There are Medicare strike forces in 10 cities around of the country, through which charges have been brought against 3,700 defendants who falsely billed the program over $14 billion. The strike forces are partnership between D.C.-based and state-based federal prosecutors, the FBI and the inspector general of the U.S. Department of Health and Human Services.

Sandra Moser, a former assistant U.S. attorney in New Jersey who heads the Justice Department’s fraud section, says data analysts look for outliers – sometimes as obvious as someone billing for 40 days a month or 30 hours a day, other times perhaps the doctor who bills the most times for an esoteric procedure with an incredibly high reimbursement rate.

“The fraudsters know how to go after and identify what the highest reimbursable rates are, and they generally not great at stopping themselves and showing moderation. And so we look for those patterns,” Moser said.

Moser says the same concept applies to opioid prescriptions, such as looking for doctors that prescribe lethal combinations of two different types of the painkillers.


New Jersey: Decoded cuts through the cruft and gets to what matters in New Jersey news and politics. Follow on Facebook and Twitter.


Michael Symons is State House bureau chief for New Jersey 101.5 and the editor of New Jersey: Decoded. Follow @NJDecoded on Twitter and Facebook. Contact him at michael.symons@townsquaremedia.com

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