Rapid Response Strike Force

National Rapid Response Strike Force

Unlike prior Strike Forces in the Health Care Fraud Unit, which were focused more on fraud in particular locales (i.e., Miami, Los Angeles, Newark, Detroit), the National Rapid Response Strike Force’s mission is to (1) investigate and prosecute the country’s largest and most complex health care fraud cases, with a focus on investigations and prosecutions of individuals and corporate health care fraud cases; (2) coordinate nationwide enforcement actions and multi-jurisdictional investigations by providing support and subject matter expertise to the Health Care Fraud Unit’s Medicare Fraud Strike Forces and U.S. Attorney’s offices across the country; and (3) enable the Fraud Section to quickly tackle new issues of national priority, such as COVID-19, and emerging trends in health care fraud schemes, as identified through data analytics and partnerships with the Civil Division’s Fraud Section and Consumer Protection Branch, U.S. Attorney’s offices, state Medicaid Fraud Control Units, the FBI, HHS-OIG, and other agencies.  The National Rapid Response Strike Force is composed of some of the country’s most experienced health care fraud prosecutors, including former Assistant U.S. Attorneys, law firm partners, and Trial Attorneys with decades of courtroom experience.

The National Rapid Response Strike Force’s recent successes reflect the effectiveness of this model.  For example, the National Rapid Response Strike Force has led and coordinated the Department’s nationwide initiatives, as well as its prosecution of cases involving corporate health care fraud, telemedicine, Sober Homes, and COVID-19 fraud.

Corporate Health Care Fraud:  In corporate health care fraud prosecutions, the National Rapid Response Strike Force in 2022 obtained the convictions of the owners of a number of rural hospitals for a $1.4 billion pass-through billing scheme that used the hospitals as billing shells to submit fraudulent claims for lucrative laboratory testing.  In this scheme, individuals took over small, rural hospitals, often in financial trouble.  They then billed private insurance companies through those hospitals for millions of dollars of expensive and often medically unnecessary testing, conducted at outside laboratories with which they have a relationship.  This was one of the largest health care fraud cases ever charged and involved first-in-the-nation charges for rural hospital billing fraud. 

In September 2022, the National Rapid Response Strike Force also obtained, in collaboration with the Fraud Section’s Market Integrity and Major Frauds Unit, the conviction of the president of a California-based medical technology company in connection with his alleged participation in schemes to mislead investors, to manipulate the company’s stock price and to conspire to commit health care fraud in connection with the submission of over $69 million in false and fraudulent claims for allergy and COVID-19 testing.  The case was the first criminal securities fraud prosecution related to the COVID-19 pandemic that was brought by the Department of Justice, and the National Rapid Response Strike Force has recently brought additional cases involving financial and health care fraud by medical technology companies. 

These recent successes at trial build on prior corporate health care fraud work.  Examples of successful corporate health care fraud prosecutions include the resolution with a major U.S. hospital chain, Tenet Healthcare Corporation, and two of its Atlanta-area subsidiaries, which paid over $513 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States and to pay kickbacks in exchange for patient referrals.  

Telemedicine:  In five successive enforcement actions, the Strike Force has led efforts in bringing charges and securing guilty pleas involving over $10 billion in alleged telemedicine fraud.  In these schemes, telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.  Often, patients were lured into the scheme by an international telemarketing network and the durable medical equipment, test results, or medications were not provided to the beneficiaries or were worthless to the patients and their actual primary care doctors, while the misdirection, fake diagnoses, and unneeded tests misled patients and delayed their chance to seek appropriate treatment for medical complaints.  Proceeds of the fraudulent schemes allegedly laundered through international shell corporations and foreign banks. 

These efforts have obtained direct results for American taxpayers:  CMS-CPI has calculated that the deterrent impact of just one of the telemedicine enforcement actions was an estimated cost avoidance of over $1.9 billion in the amount paid by Medicare for orthotic braces in the time after that enforcement action, as a result of a drop in claims for orthotic braces that preserved the Medicare trust fund for legitimate medical care. 

Sober Homes Initiative: The National Rapid Response Strike Force leads the national Sober Homes Initiative that targets physicians, owners and operators of substance abuse treatment facilities, and patient recruiters (also known in the industry as “body brokers”).  These individuals sacrifice genuine care and prey upon those suffering with substance abuse issues by offering them illegal financial incentives to enroll at certain facilities, billing for medically unnecessary therapy and/or therapy never actually provided, and perhaps most tragically, preventing patients needing help from getting the care they need. 

The Sober Homes Initiative has resulted in charges and guilty pleas involving 27 criminal defendants in connection with over $1 billion in alleged false billings for fraudulent tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.  In 2022, NRRSF prosecutors obtained convictions in four separate Sober Homes trials in the Southern District of Florida that collectively involved hundreds of millions of dollars in fraud and significant harm to addicted patients. 

The defendants in these cases are alleged to have participated in schemes involving illegal kickbacks and bribes for the referral of scores of patients to substance abuse treatment facilities.  Sometimes patients are even given drugs prior to admission to more easily qualify for substance abuse treatment.  The facilities then subject these patients often procured through kickbacks to medically unnecessary urine drug testing—often billing thousands of dollars for a single test—and therapy sessions that were not always provided, resulting in millions of dollars of fraudulent billing to private insurers.  Medical professionals also prescribed controlled substances and other medications outside the scope of medical practice, and even to entice patients to stay at the facility.  The consequences in terms of patient harm can be significant – addictions go unaddressed, they are even allowed to use drugs at the facilities with no consequences, and they can thus relapse and even overdose. 

Coronavirus Response: The National Rapid Response Strike Force has assumed a leadership role in chairing the interagency COVID-19 fraud working group and working with federal law enforcement and public health agencies to identify and combat health care fraud trends emerging during the crisis.  This involved coordination and training of other Strike Forces and U.S. Attorney’s Offices regarding emerging COVID-19 health care fraud scams and offering support to their investigations and prosecutions, including data analytics support. The collaborative, nationwide response facilitates information sharing in order to quickly identify, investigate, and prosecute COVID-19 health care fraud schemes.         

Examples of cases prosecuted to date include cases against corporate executives, medical professionals, and marketing organizations in connection with schemes offering free COVID-19 testing to obtain Medicare beneficiary information that then is used to submit medical claims for unrelated and medically unnecessary – and far more expensive – tests or services, as well as for tests or services that were never provided.