Some lawyers say the U.S. Attorney's office in Charlotte is building a reputation for being especially aggressive in prosecuting health care fraud. As an example, the office earlier this year won its largest settlement ever with a single doctor.
The case against Dr. Mark Tuan Le started with a tip. In mid 2012, one of the Huntersville doctor's former employees called a federal hotline for reporting fraud. Soon after, Assistant U.S. Attorney Jonathan Ferry started analyzing Medicare and Medicaid records.
"If you see data that indicates there may be a problem, you still need information that shows that is an actual problem as opposed to a justified thing and that the doctor happens to focus in this area or something like that," he says.
Ferry helps lead this kind of investigation for the U.S. Attorney's office in Charlotte. His team interviews witnesses and patients, subpoenas the doctor's medical records, and looks for patterns.
"What we saw was that Dr. Le was doing a couple things," Ferry says. "One was he was billing hundreds of procedures on family members. And we also saw that he was billing these procedures on others that didn't have medical necessity for them."
For example, there's an expensive heart test called an echocardiogram, or echo. Ferry says at Dr. Le's Northcross Medical Center, just about anybody who had a heart got an echo.
Uncovering this kind of fraud requires expertise sorting through troves of billing data. So the task force Ferry works with includes accountants turned detectives.
"Nearly all of our investigators have accounting backgrounds," says Eddie Kirby from the Medicaid Investigations Division of the North Carolina Attorney General's office. "We have folks who come to our office where this is their first foray into law enforcement."
The task force also includes investigators from the FBI, the federal Health and Human Services department and the IRS. It's a state-federal effort the U.S. Attorney's office coordinates.
That office is raising its profile nationally, says James Wyatt, a private attorney who's been involved in health care fraud litigation for about 20 years.
"This office has had a number of significant verdicts that relate to solely sort of North Carolina issues, but it is now getting significantly involved in cases that are national in scope," he says.
That includes a nearly $100 million settlement against Community Health Systems in August. Wyatt represents a Mooresville doctor who was a whistleblower in that case.
Ferry, the assistant U.S. Attorney, says the settlement with Dr. Le was ultimately $6.2 million – the largest his office has ever landed against a single doctor.
"Sometimes we face situations in which there's been a fraud and we can't recover the funds because they're gone," he says. "I think it's gratifying in this case to be able to recover in excess of the damages that were caused to the government."
The law allows the federal government to do that as a way of deterring other doctors from stealing taxpayer money from Medicare and Medicaid.