Testimony Before the United States House of Representatives 
Committee on Ways and Means 
Subcommittee on Oversight 
 
 
 
 
Health Care Fraud Investigations 
 
Testimony of: 
 
Abhijit Dixit 
Special Agent 
Office of Investigations 
  Office of Inspector General    
Department of Health and Human Services 
 
 
 
 
 
September 28, 2016 
10:00 a.m. 
Location:  1100 Longworth House Office Building 
 
 
 
 
 
 
 
 
  Testimony of: 
Abhijit Dixit 
Special Agent, Office of Investigations 
Office of Inspector General, U.S. Department of Health and Human Services 
 
Good morning, Chairman Roskam, Ranking Member Lewis, and distinguished Members of the 
Subcommittee.  I am Abhijit Dixit, a Special Agent with the U.S. Department of Health and 
Human Services (HHS), Office of Inspector General (OIG).  I appreciate this opportunity to 
describe the work that my fellow OIG agents and I in Detroit do to protect Medicare and 
Medicaid beneficiaries and to fight health care fraud.  
 
I am here this morning to give you a field agents perspective.  I investigate medical providers 
that defraud Federal health care programs through the submission of false claims or other 
prohibited acts and, in doing so, place the safety and well-being of program beneficiaries at risk.  
Today, my testimony will describe both the manner in which OIG investigates allegations of 
health care fraud and the schemes that present continued threats to the integrity of the Medicare 
and Medicaid programs. 
 
The work of OIGs special agents has a valuable and positive impact across the country.  During 
fiscal years 2013 through 2015, OIG investigations nationally resulted in more than $10.9 billion 
in investigative receivables, or dollars ordered or agreed to be paid to Government programs as a 
result of criminal, civil, or administrative judgments or settlements. In addition, our 
investigations led to 2,856 criminal actions, 1,447 civil actions, and 11,343 program exclusions.1  
Beyond these statistical accomplishments, OIG special agents are on the front lines, interacting 
daily with Medicare and Medicaid beneficiaries and providers.  Though difficult to quantify, a 
valuable part of our work is protecting beneficiaries from harm. 
 
It is important to point out that our special agents work is typically conducted in partnership 
with other Federal and State agencies as well as the private sector.  We partner with other 
investigators, auditors, evaluators, and attorneys in OIG and in other agencies to most effectively 
investigate and prosecute fraud.  These partnerships are invaluable in our enforcement successes.  
For example, OIG has strong relationships with Medicaid Fraud Control Units (MFCUs), which 
are State-level investigative units with which we work on the majority of our Medicaid 
investigations.  As a former MFCU investigator, I know firsthand the benefits of leveraging the 
specialized knowledge of agents in each States Medicaid program.  Through several task forces 
and other partnerships we often work hand in hand with multiple Federal agencies.   
 
OIG also participates in Medicare Fraud Strike Force teams that combine the resources of 
Federal, State and local law enforcement entities to prevent and combat health care fraud across 
the country.  The Medicare Strike Force effort began in March 2007 and expanded to seven 
cities, including Detroit, in 2009.  The Strike Force, which now operates in nine locations, has 
charged more than 2,900 defendants who collectively have falsely billed the Medicare program 
over $8.9 billion.  A clear example of success came in June 2016, when I was among 
                                                           
1 OIG has the authority to exclude individuals and entities from federally funded health care programs.  The effect of 
an exclusion is that no payment will be made by any Federal health care program for any items or services 
furnished, ordered or prescribed by an excluded individual or entity.   
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  approximately 350 OIG agents who partnered with more than 1,000 other law enforcement 
personnel to execute the largest health care fraud takedown in history.  The takedown, led by the 
Medicare Fraud Strike Force, resulted in criminal and civil charges against 301 individuals, 
including 61 doctors, nurses, and other licensed medical professionals, for their alleged 
participation in health care fraud schemes involving approximately $900 million in false billings.   
 
Through coordinated enforcement efforts across the country, including those of the Strike Force 
teams, criminal prosecutions and monetary recoveries have increased while we have seen a 
measurable decrease in payments for certain medical services targeted by fraud schemes. We 
believe that one measure of success is that annual Medicare payments for home health services 
nationally decreased by more than $1 billion since calendar year 2010.  In Detroit, payments to 
home health care agencies have decreased by $100 million annually.  These declines followed 
targeted enforcement activities as well as policy changes, such as the implementation of 
temporary moratoriums on new home health agency enrollments, increased payment 
suspensions, and payment reforms.  OIG identifies systemic vulnerabilities and makes 
recommendations to the Centers for Medicare & Medicaid Services (CMS) to better prevent 
fraud.  In the case of moratoriums, OIG provides information and CMS evaluates the existing 
provider and supplier base, including factors such as how a temporary moratorium will affect 
access to care.  Despite this measurable success, more work remains in Detroit and across the 
nation.   
 
 
OIG USES SOPHISTICATED DATA ANALYTICS AND REAL-TIME FIELD 
INTELLIGENCE TO ENHANCE ENFORCEMENT EFFORTS 
 
The schemes used to steal money from Medicare and Medicaid are multifaceted.  Schemes can 
be as simple as billing for a service not actually performed, or as complex as an organized 
criminal enterprise.  The perpetrators of these frauds can range from highly respected physicians 
to individuals with no prior experience in the health care industry.  Regardless, they all have one 
thing in common  greed.  Unscrupulous providers motivated by greed often put profit before 
patients health and safety, creating potentially dangerous patient care environments.   
 
Health care fraud cases share similarities.  However, no two cases are exactly the same, and each 
investigation presents unique challenges.  OIG receives complaints or investigative leads from a 
variety of sources, including the OIG hotline, law enforcement partners, beneficiaries, providers, 
and informants.  Traditional means of identifying fraud include conducting interviews of 
cooperating witnesses and surveillance.   
 
To accomplish our mission, OIG employs data analytics and real-time field intelligence to detect 
and investigate program fraud and to target our resources for maximum impact.  OIG is a leader 
in the use of data analytics, employing a dedicated data analytics unit.  Gathering claims data and 
other electronic information from multiple sources and efficiently and effectively merging that 
information into a manageable and usable format is a highly specialized skill.  Our special agents 
have direct access to Medicare claims data and use innovative methods to analyze billions of 
data points to identify trends that may indicate fraud, geographical hot spots, emerging schemes, 
and individual providers of concern.  We also use data throughout an investigation to identify 
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  potential witnesses or co-conspirators and conduct interviews as efficiently and effectively as 
possible.    
 
It should be noted that although data analytics is important and helpful, it is necessary to 
combine the insights gained from it with valuable field intelligence.  For example, the data alone 
may not reveal the complex structure of a criminal enterprise.  Data analytics may not determine 
whether kickbacks are being paid, services are being rendered, or patients are being harmed.  
Traditional field intelligence obtained by investigators through witness and subject interviews, 
execution of search warrants, surveillance, and evidence review is still critical in revealing the 
scope and nature of a fraud scheme.  
 
 
OIG PRIORITIZES FRAUD CASES THAT JEOPARDIZE PATIENTS HEALTH OR 
SAFETY 
 
I would like to emphasize that Medicare and Medicaid fraud affects more than the public coffers.  
When fraud is committed, beneficiaries can suffer harm and neglect.   
 
OIG addresses all allegations of fraud as swiftly as possible by allocating scarce investigator 
time on the basis of available information.  However, certain allegations of patient harm further 
heighten the sense of urgency, and we mobilize our teams and work around the clock to protect 
patients. An example of this, in which I was personally involved, is the case of a Detroit-area 
hematologist-oncologist, Dr. Farid Fata, sentenced last year to serve 45 years in prison.  Dr. Fata 
used false cancer diagnoses and unwarranted, dangerous treatments as tools to steal millions of 
dollars from Medicare and private insurance companies.  
 
When the Department of Justice (DOJ) received a complaint from Dr. Fatas office manager, 
OIG and our law enforcement partners acted immediately.  We simultaneously began the initial 
phase of the investigationdetermining whether the allegations were credibleand took steps 
to protect the potentially affected patients.   
 
From the investigative perspective, we retrieved and analyzed near real-time claims data to 
identify witnesses who could give us more information.  We also began deploying traditional law 
enforcement techniques, which included conducting surveillance, interviewing key witnesses, 
serving subpoenas, and reviewing documents.  We established a command post as a single point 
for investigators to relay information immediately to a prosecution team.  All available special 
agents were given assignments and worked through the weekend to identify the credibility of the 
allegation.  Once we were able to develop enough evidence to corroborate the initial allegation, 
we obtained several warrants.  Before executing any warrant, we develop an operational plan.  In 
this case, the plan included information about the subject to be arrested, his criminal history and 
background; team assignments; emergency information, including the address of the nearest 
hospital; and detailed information about the location where the search and arrest warrants would 
be executed.  A judge signed the warrants at approximately 4 a.m.  On the same day, just after 6 
a.m., the doctor was arrested and six search warrants were executed.   
 
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  OIG special agents are trained to identify and address potential patient harm.  Using this training, 
I worked with the law enforcement team before the operation was executed to protect patients in 
many ways beyond the criminal investigation and prosecution.  We deployed additional staff to 
each operational site where warrants were executed to provide information directly to patients 
and the public.  OIG agents and other law enforcement personnel referred affected patients to a 
specially created victim-assistance hotline, staffed by DOJ, which provided around-the-clock 
information.   
 
We accomplished all of thisthe initial phase of the investigation, the arrest, and the patient 
protection effortsin just 5 days.   
 
Additionally, CMS suspended payments to Dr. Fata.  As evidence was uncovered, it became 
clear that patient-related decisions were made to maximize reimbursement rather than to advance 
the best interests of the patient.  Dr. Fata pleaded guilty to health care fraud and other charges for 
his role in this scheme that included administering medically unnecessary infusions or injections 
to 553 individual patients and submitting to Medicare and private insurance companies 
approximately $34 million in fraudulent claims.    
 
While such stark examples of direct physical harm to patients are rare, the case of Dr. Fata is far 
from the only example of a provider subjecting patients to significant harm in the pursuit of 
profit.   
 
Dr. Aria Sabit, another Detroit-area physician, performed unnecessary, invasive spinal surgeries 
and implanted costly and unnecessary medical devices, all at the expense of his patients health 
and welfare.  Dr. Sabit, a neurosurgeon, lied to patients about the procedures medical necessity 
and what he actually did.  He persuaded patients to undergo spinal fusion surgery that included 
specific medical devices designed to stabilize and strengthen the spine.  But he did not perform 
that surgery.  Instead, Dr. Sabit performed a different operation not related to lumbar and 
thoracic fusion.  He also sometimes billed for implants not provided and falsified operative 
reports that he knew would later be used to support his fraudulent insurance claims.  Dr. Sabit 
subsequently billed Medicare, Medicaid and private insurance companies $11 million for those 
fraudulent services.  In some cases, patients experienced serious bodily injury and ended up in 
worse condition than before the surgery.  Dr. Sabit has pleaded guilty in two separate criminal 
cases and awaits sentencing. 
 
Other examples, which are found in numerous OIG investigations, include physicians writing 
medically unnecessary controlled substance prescriptions for pseudo-patients in exchange for 
cash or submission by a patient to medically unnecessary services  for which the provider 
would bill.  Such medically unnecessary services include diagnostic testing, uncomfortable nerve 
conduction studies, or monthly office visits.   
 
 
CERTAIN HEALTH CARE PROGRAMS ARE CONSISTENTLY TARGETS FOR 
FRAUD  
 
The fraud schemes we see in Detroit mirror those across the country, but with distinct variations.  
Often, fraud schemes evolve and migrate from one region of the country to another.  To avoid 
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  detection as enforcement increases, either through law enforcement action or policy and payment 
changes, criminal networks may conduct geographical research to test combinations of billing 
codes identifying payment edits before the breakout billing and subsequent submission of a 
high number of false claims.  The breakout billing is often visible through targeted data 
analytics, and OIG special agents work with our multidiscipline experts to identify these spikes 
early to prevent further fraud.  Several organized criminal enterprises migrated from Miami, 
which is often considered ground zero for health care fraud, to Detroit.  We have closely 
coordinated with our Miami office to target these schemes.  Program areas susceptible to 
widespread fraud include, among others, home- and communitybased services, and 
prescription drugs.  OIG focuses on these areas and they represent a significant portion of our 
enforcement efforts, both in Detroit and nationally. 
 
 
OIG PRIORITY:  ENFORCEMENT AND PREVENTION OF HOME- AND 
COMMUNITY-BASED SERVICES FRAUD 
 
Home- and community-based services, including Medicare home health and Medicaid personal 
care services (PCS), help beneficiaries continue to live in their homes and avoid costly and 
disruptive facility-based care.  Although OIG has had significant successes in combatting fraud 
in these programs, we continue to identify and investigate fraudulent providers in Medicare 
Strike Force areas, including Detroit.  OIG home health investigations (which is where I have 
had the most experience) have resulted in more than 350 criminal and civil actions and $975 
million in investigative receivables for fiscal years 2011 - 2015. 
 
Home health fraud schemes generally involve billing for services that are not medically 
necessary and/or not provided.  For example, in April 2016 Dr. Jacques Roy and three home 
health agency (HHA) owners were convicted for their roles in a $375 million fraud scheme.  At 
the time, this was the nations largest home health care fraud carried out by a single doctor.  As 
part of the scheme, the perpetrators recruited patients at homeless shelters, in grocery stores, and 
by door-to-door solicitation to sign up for Medicare home health services.  Dr. Roy falsely 
certified, and later recertified, beneficiaries as being eligible to receive home health care.  His 
office staff falsified medical documentation to support the eligibility certifications and support 
billing for services that were never provided.  Dr. Roy also visited some of the recruited patients 
homes and then billed Medicare for unnecessary home visits.  Two additional HHA owners and 
an office manager pleaded guilty for their roles in this scheme.  Dr. Roy awaits sentencing. 
 
OIG identified Dr. Roy following proactive data analytics targeting suspicious billing. The 
physicians office processed and approved certifications for 11,000 unique Medicare 
beneficiaries from more than 500 different home health agencies. Typical physicians refer fewer 
than 100 patients for home health services.  Our data analysis identified this physician as an 
extreme outlier, but that was only the beginning of this investigation.  The massive scope, 
multiple co-conspirators, and falsified records meant the dedication of significant OIG 
investigative resources to protect patients and taxpayer dollars.  During execution of the search 
warrant in this case, the amount of physical and digital evidence collected was unprecedented, 
and presented challenges to the investigative team.  Arrangements were made to store the over 
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  900 boxes seized, and nearly all of OIGs digital investigations staff were required to handle the 
40 terabytes of data seized.   
 
The investigation of six metro Detroit-area HHAs is another example in Michigan involving 
kickbacks and the billing of Medicare for nonrendered or medically unnecessary home health 
services.  Our investigations resulted in the convictions of 14 physicians, HHA owners, and 
patient recruiters.  The investigation revealed that beneficiaries personal information was 
acquired by patient recruiters.  In exchange for their personal information, the recruiters gave the 
beneficiaries cash and illicit prescription drugs.  One of the HHA owners, Naseem Minhas, 
charged with $4 million in fraudulent billing, admitted that in addition to paying kickbacks, he 
assisted in creating false patient files to make it appear as though the patients needed and 
received the services.  To date, these convictions have resulted in just over 36 years in prison 
sentences. 
 
OIG is committed to protecting the financial integrity of home- and community-based services 
and the health and welfare of the people served.  We previously published a personal care 
services Portfolio2 and recently published a home health online Portfolio,3 which pulls together 
information about our body of home health work, including enforcement actions, reports, and 
recommendations.  
 
 
OIG PRIORITY:  ENFORCEMENT AND PREVENTION OF PRESCRIPTION DRUG 
FRAUD 
 
Another priority for OIG is enforcement action against and prevention of prescription drug fraud.  
Prescription drug abuse is a rapidly growing national health care problem, and our nation is in 
the midst of an unprecedented opioid epidemic.4  As of early September 2016, OIG had 678 
pending complaints and cases involving Medicare Part D, which represents a 152-percent 
increase in the last 5 years. 
 
Medicare and Medicaid prescription drug diversionthe redirection of prescription drugs for an 
illegal purposeis a serious component of this epidemic.  Although the diversion of controlled 
substances, such as opioids, is of paramount concern, the diversion of noncontrolled substances 
is becoming more common.  In these cases, noncontrolled substances are combined with opioids 
and other controlled substances to exaggerate the users high  making noncontrolled drugs 
susceptible to abuse.  Fraud related to both controlled and noncontrolled drugs results in 
significant financial losses to Medicare and Medicaid and, more importantly, may also result in 
patient harm and even death.   
 
In one example of prescription drug diversion, a Michigan pharmacist and a network of 
pharmacies were among 37 defendants convicted for their roles in a widespread scheme to 
defraud Medicare and Medicaid of nearly $58 million.  According to the indictment, the 
                                                           
2 Personal Care Services: Trends, Vulnerabilities, and Recommendations for Improvement (OIG-12-12-01) 
3 HHS OIG Online Portfolio: Home Health 
4  Centers for Disease Control and Prevention, Prescription Painkiller Overdoses at Epidemic Levels [press release], 
Nov. 1, 2011. 
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  pharmacist either owned or controlled 26 pharmacies, although he concealed his ownership and 
control over many years through the use of straw owners.  The pharmacist offered and paid 
kickbacks, bribes, and other inducements to prescribers who wrote fraudulent prescriptions for 
patients under Medicare, Medicaid, and private insurance, and directed the patients to fill the 
prescriptions at one of his pharmacies.   
 
The scheme was detected when OIG special agents reviewed prescription drug claims data for a 
physician under investigation in another matter.  The network of pharmacies began to emerge as 
an outlier.  OIG joined forces with other law enforcement agents who had also identified the 
pharmacy network as suspicious.  The investigation involved examining records for evidence of 
kickback payments, interviewing witnesses and other cooperators, surveillance, and the 
execution of multiple arrest and search warrants.   
 
Evidence revealed that the pharmacist and those working for him billed Medicare and other 
insurers for dispensing the medications, despite the fact that the medications were medically 
unnecessary and/or were never provided.  From January 2009 to August 2011, his pharmacies 
dispensed approximately 250,000 doses of OxyContin, 4.6 million doses of Vicodin, 1.5 million 
doses of Xanax, and 6,100 pint bottles of codeine cough syrup. 
 
The pharmacist was sentenced to 17 years in prison and ordered to pay $18.9 million in 
restitution.  In addition, 14 other pharmacists, 9 doctors, 6 business associates, 4 patient 
recruiters/drug dealers and 3 pharmacy technicians were sentenced to a combined 9212 years in 
prison, and ordered to pay collectively more than $84 million in restitution. 
 
Combatting prescription drug fraud continues to be an enforcement priority, and OIG will remain 
vigilant in investigating emerging trends. 
 
 
CONCLUSION 
 
In conclusion, I would like to underscore OIGs commitment to protecting program beneficiaries 
and fighting health care fraud.  The highly specialized investigative work of our special agents, 
combined with cutting edge data analytics, continue to prove effective in making a valuable and 
positive impact.  By leveraging partnerships and building on the success of the Medicare Strike 
Force, OIGs investigators will continue to prevent, detect, and fight fraud.     
 
It has been a pleasure to discuss our work and to describe some of our recent successes in 
protecting Medicare and Medicaid beneficiaries from harm and taxpayer dollars from theft.  
Thank you again, for inviting OIG to speak with the Subcommittee today.  I hope that our work 
and this testimony will assist you in your oversight efforts.  I would be happy to answer any of 
your questions. 
 
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