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The Department of Justice continues to crack down on allegations of bribery in the healthcare industry. In the latest case, the government accused a Texas surgeon of paying and receiving bribes in relation to his medical practice.
The scheme allegedly involved the exchange of bribes for referrals of patients with “high-reimbursing, out-of-network private insurance” providers.
Lawmakers recently passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act. This proposal passed with bipartisan support and was signed into law by President Donald Trump on October 24, 2018. The SUPPORT Act will have a major impact on healthcare throughout the country.
Main impact: Expansion of anti-kickback prohibitions
The law includes a provision that essentially works to extend anti-kickback provisions with medical labs and clinical treatment facilities to include private insurance providers. The language of the provision is broad, prohibiting the use of any rebate or kickback "directly or indirectly, overtly or covertly, in cash or in kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory." This change will likely increase the risk of medical professionals accused of anti-kickback type violations.
Retaliation, in the legal world, occurs when an employer illegal responds to an employee’s actions with a negative consequence. This consequence could range from loss of a bonus to termination of the employee’s position. Depending on the details, an employee may be able to hold the employer legally accountable for this wrongdoing through a lawsuit.
A case as an example: Retaliation is illegal
It would seem advantageous for medical professionals to discuss concerns about the quality of care provided to patients. One would hope hospital executives would appreciate updates from physicians about concerns.
Unfortunately, this is not always the case.
The Department of Justice (DOJ) recently released the indictment for four men and seven companies the agency has accused of involvement in a billion-dollar health care fraud scheme. The accusations include conspiracy to commit health care fraud, mail fraud and introduction of misbranded drugs into interstate commerce and result in 32 criminal charges.
According to the DOJ, these individuals and companies deceived tens of thousands of patients and over 100 medical professionals with an elaborate telemedicine scheme that provided prescriptions that were allegedly "massively" overpriced for a three-year period of time spanning from 2015 to 2018. The indictment states the accused submitted a minimum of $931,000,000 in fraudulent claims during this time period.
The government has come down hard on yet another physician accused of playing a role in the nation’s opioid crisis. Seven individuals died from overdose, allegedly from medications prescribed by the accused physician. The government states the distribution of these controlled substances was outside the usual course of professional practice. The prosecution further argued that there was not a legitimate medical purpose for the prescriptions.
The government also accused the physician of seven counts of possession with intent to distribute and distribution of controlled substances. The government classifies these medications as controlled substances because they contained fentanyl, morphine, oxycodone, oxymorphone, methadone, hydrocodone, alprazolam, and zolpidem.
It takes a variety of support staff to keep a nursing facility running. One key element: nurses. Nurses provide medical care and compassion to residents at these facilities. Without a strong nursing staff, nursing homes are not successful.
Nursing home faces allegations of failing to check licenses of nurses
What makes a nurse a nurse? In the most basic sense, a nurse is an individual that holds a nursing license. Anyone that presents him or herself as a nurse should hold the proper licensure. A family member of a resident at a nursing home recently accused a nurse of failing to have the appropriate licensure. He stated he looked for the nurse in the state's nursing license database and was unable to find her listed within the database.
A sheriff’s department in Texas has charged two office administrators at medical clinics with healthcare fraud. The state has accused the women of conspiring with a doctor at the clinic to file fraudulent claims with the Office of Worker’s Compensation.
According to the government’s allegations, the scheme was set up to run as follows:
Allegations of wrongdoing can haunt the accused for the rest of his or her life. This is particularly true when the allegations involve government allegations of breaking the law. Is it possible to overcome these allegations and move on to live a successful and fulfilling life? In short, the answer is yes, but the road to success is a difficult one. A recent political battle provides an example.
Politics provide a valuable lesson: The political landscape right now is harsh. Regardless of one's political leanings, it is safe to say that anyone getting into politics will face serious criticism and will have their past thoroughly reviewed and shared with the public.
The Department of Justice (DOJ) continues to crackdown on allegations of healthcare fraud. The agency’s most recent examples a psychologist and his wife who ran a psychological practice. The government has accused the couple of partaking in an elaborate billing scheme to defraud Medicaid.
Our experienced Texas-based health care lawyers are here to help you and your business succeed. Please call 512-481-8000 or contact our law firm online.
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