a Graph 7: DME Submitted & Paid in S/FL(Miam-Dade & Broward Cos)
Since Medicare Fraud Strike Force vs Previous 12-Month Period
$3.50
@ March 2006-Fe b 2007
$3.00) $2,761 mi March 2007-Fe b 2008
$250 W Savings During MFSF
$200
$1.50
ay 8100 $0.687
—& soso $0.353
i $0.00 ;
DME Submitted, DMEPaid
$0.50 -$0.334
$1.00
$1.50
$2.00
$2.50
Graph 8: South Florida (Broward & Miami-Dade Co's) DME Claims to
Medicare Part B, March 2006-February 2008 ($ in Millions)
$300
$325 —@ DME $ Submitted
$300 .
9275 —&— DME $ Paid
$250
$235 12106-2107: CMSINSC Revoke 634#s
$200
$175 March thru October 2006: ; |
$150 || Prior to Supplemental CMS & 2107:USAO & OIG Equity Excise Ancd
$125 Law Enfremt Interventions in 3/07: Strike Force Begins; AG Ancd 5/07
$100 South Florida
$7 7 a Yio
sa) re
$35 Talia a a ar
9

M- A- M- J- Je A> S- O- N- De J- Fe M- As Me Je Je As S- O- N- De J F-
06 06 06 06 06 06 06 06 06 06 07 O07 O7 OF O7 O7 OF OF O7 OF OF O7 O8 08

H:\Frd_Health\DME Strike Forces\Accomplishments_Stats\Fact Sheets\Dec 2009 Updates (USAO+DOJ)\fraud medicare overall fact sheet_14Dec09.doc

Daae Saf



Graph 5: Total Medicare Fraud Strike Force (All Phases)
Jury Trials and Outcomes, 2007- 2009

5

[a Trials (17) Phase 1: Miami (12 trials) in black;

m Guilty (22) Phase 2: Los Angeles (5 trials) in gray
(£4 | OAcquittals «|

o

n

Number of Jury Trials per Month

=

o

]
Mar07 Jun07 Jul07 Aug07 Oct07 Dec07 Feb08 Mar08 Apr08 Sep08 Oct08 Mar09 Jun09 July09 Nov09

Graph 6: Total Medicare Fraud Strike Force (All Phases) -- Number of Convicted
Defendants Sentenced to Imprisonment or Probation (as of Dec. 15, 2009)

30 Years |:

10 Years or More
5 to 10 Years

3 to 5 Years

4to11 Months | 8

|
1 to 3 Years 78

Probation Only 10

a 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

Page 4 of 5


FACT SHEET
MEDICARE FRAUD STRIKE FORCES

The Medicare Fraud Strike Force supplements the criminal health care fraud enforcement activities of
the U.S. Attorneys’ Offices by targeting chronic fraud as well as emerging or migrating schemes
perpetrated by criminals operating as health care providers or suppliers.

Formation:

In March 2007, the Criminal Division’s Fraud Section working with the local U.S. Attorneys’ Offices,
law enforcement partners in the Department of Health and Human Services (HHS), and state and local
law enforcement agencies launched the Medicare Fraud Strike Force in Miami-Dade County, Fla., to
prosecute individuals and entities that do not provide legitimate health care services, but exist solely
for the purpose of defrauding Medicare and other government health care programs. DOJ and HHS
expanded the Strike Force by rolling out a second phase in the Los Angeles metro area in March 2008,
a third phase in the Detroit metro area in June 2009, a fourth phase in the Houston metro area in July
2009, and a fifth phase in New York City in December 2009.

Strike Force prosecutions are “data driven” and target individuals and groups that are actively
involved in ongoing fraud schemes. Assets purchased with the ill-gotten gains from these fraudulent
activities — including homes, cars and equipment — are seized at the time of arrest and forfeiture of the
criminal proceeds is sought in order to return stolen funds to the Medicare Trust Fund.

Perpetrators are charged for engaging in criminal health care fraud conspiracies and all “relevant
conduct” from the conspiracy is taken into consideration at sentencing. As a result, the average Strike
Force prison sentences exceeded by 20 percent the overall national average sentence in federal health
care fraud cases in 2008.

Targeted providers have been associated with hundreds of millions of dollars in fraudulent claims
submitted to Medicare for a number of schemes, including claims made for durable medical
equipment (DME) supplies such as power wheelchairs and orthotics, “compound” medications for use
with DME supplies (such as inhalers and nebulizers), HIV infusion clinics, enteral nutrition and
feeding supplies, and fraudulent billing companies. Prosecutors have expanded the scope of targeted
schemes to include fraudulent home health agencies, independent diagnostic testing facilities and
physical and occupational therapy clinics.

Key Accomplishments (to date):

Strike Force prosecutors from the U.S. Attorneys’ Offices and DOJ Criminal Division have sought
more than $420 million in court-ordered restitution to the Medicare program in 222 cases filed
involving 462 defendants who have been charged with a variety of criminal health care fraud offenses.

Over 250 guilty pleas have been secured and 17 jury trials have taken place, resulting in guilty
verdicts against 22 defendants.

Nearly 200 defendants have been sentenced to prison, with sentences ranging from four month to 30
years. The average length of sentence is 45 months. Since the Strike Force operations began in
Miami-Dade County, there have been estimated reductions of $1.75 billion in DME claim

submissions and $334 million in DME claims paid by Medicare. (This is based on a 12-month before-vs.-after
Strike Force operations comparison of Medicare claims submissions and payments in Miami-Dade Co., and does not specifically
claim an exclusive cause and effect relationship.)

Page 1 of 5


Graph 1: Total Medicare Fraud Strike Force Prosecutions (as of Dec. 15, 2009)
Phases 1 (SD/FL); 2 (CD/CA); 3 (ED/MI); 4 (SD/TX); and 5 (ED/NY)

Cases Filed

Defendants Charged |
Trial Convictions
Pending (Trial or Plea)

Guilty Pleas

Fugitives* 31

Dismissals | 5

Acquittals |: |

0 50 100 150 200 250 300 350 400 450 500

Graph 2: Fraudulent Claims Billed and Paid in Medicare Fraud
Strike Force Cases, as of December 15, 2009 ($ in Millions)

Amount Paid $422

Total Billed/Submitted $1,022

Infusion $344 |

Phys/Occ Therapy | $43

Home Health $70

Pharmacy $42

Unnecessary Services || $14 |

$0 $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100

Page 2 of 5


} Graph 3: Total Medicare Fraud Strike Force (All Phases) as of 12/15/09
Cased Filed and Defendants Charged by Fiscal Year, 2007-2010

|200
@ Cases Filed 222 |

180 | @ Defendants Charged 463 |

160

140

120

100

80

60

40

20

FY 2007 FY 2008 FY 2009 FY 2010

Graph 4: Total Medicare Fraud Strike Force (All Phases)
Guilty Pleas &Trial Convictions by Fiscal Year, 2007-2010 (as of Dec. 15, 2009 )

120
® Guilty Pleas 251 |

97 @ Trial Convictions 22)

dants 3
o o

Number gf Defen,
So

o

20 |

FY 2007 FY 2008 FY 2009 FY 2010

Page 3 of 5