With the recent scandals surrounding Healthcare.gov, security breaches involving health data are of major concern to the public. We read and hear about security fraud in the news all of the time. And if you haven’t been a victim yourself, chances are high that you may know someone who has. But who are the people battling to keep your information protected?
The members of the Miami Healthcare for Enforcement in Action Teams (HEAT) are some of these fighters. The Miami HEAT Teams have led hundreds of Medicare fraud investigations, which have resulted in over 600 convictions in southern Florida alone. For their efforts, the Miami HEAT Teams are finalists under the Homeland Security and Law Enforcement division for the 2014 Samuel J. Heyman Service to America Medals (SAMMIES), also known as the “Oscars” for federal employees.
Chris Dorobek of the DorobekINSIDER program spoke with one team leader and SAMMIES finalist Reginald France, an Assistant Special Agent in Charge at the Department of Health and Human Services, Office of the Inspector General.
According to the Government Accountability Office, one element of fraud known as improper payments is estimated at $50 billion in losses per year. Medicare fraud is another category, and these incidents occur across the nation. In Florida, which has the country’s highest proportion of residents over the age of 65, federal health insurance scams are widespread. Despite its prevalence, Medicare fraud is difficult to root out.
Two special agents from the Department of Health and Human Services (HHS), Reginald J. France and Omar Pérez Aybar have partnered with Department of Justice (DOJ) members Joseph Jeziorski, Randy Culp, Dan Bernstein, and Joseph Beemsterboer. Together, they coordinated investigations for the 12 special Miami HEAT Teams.
“Criminals are very innovative,” said France. “We see fraud in one area, and it transitions into another area over time. It’s a big problem, and it takes a lot of resources to stop it.”
In spite of the cleverness of these criminals, France spoke about the success of these HEAT investigators. Out of the $1.3 billion in recoveries found across the nation, $1 billion stemmed from the southern region of Florida.
“It’s a strike force team,” explained France. “We have people from the Department of Justice, federal prosecutors, FBI agents, state and local investigators, and police officers all looking at this specific crime. In order to stop these criminals, it takes a significant amount of time looking at data, interviewing people, and utilizing blue collar types of investigative techniques, such as surveillance.”
France further explained the methodology that has led to much success in Miami and across Florida.
“In Miami, we buy in from the United States Attorney’s Office or from whomever is prosecuting the case, and they are with you from the beginning giving direction and guidance on the best ways to solve these crimes,” said France.
In regards to the background and expertise of these team members, it is different for each member. “We have experts in almost every field, we have people with IT background, and people with varied experience who all want to do the same thing, which is to stop fraud in South Florida,” said France.
France continued by addressing why Florida has particularly high instances of fraud.
“One of the biggest problems we have in South Florida is kickbacks, or gratuity. A lot of our cases are surrounding beneficiaries who are getting paid,” France explained. “Those people who you would think are being impacted the most by the stealing of healthcare dollars are actually getting a benefit from the fraudsters.”
France also stressed how the work in Florida could translate to the remainder of the country.
“When you look at the blueprint of fraud, it starts in South Florida,” France said. “We take that blueprint and we share it with the teams across the country, and they all use data analytics.”