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.
Details of accusations: DOJ accuses doctor of four-year scheme
The government has accused the medical professional and his co-conspirators of spending over $40 million in bribes spanning from 2009 to 2013. Although the services were out-of-network, the physicians assured the patients the services were in-network. The DOJ then states the physicians would bill the out-of-network services to the insurance company. The practice would write off any portion that was not collected from the insurance company as bad debt.
These physicians reportedly received $200 million from the scheme. The government stated those involved in the scheme attempted to disguise the bribes by listing the funds as “marketing money.”
Plea deal accepted: Physician faces prison time for role in scheme
The accused accepted a plea deal with the government. As part of the deal, this doctor faces a five to seven-year prison sentence. He is one of 21 charged in this scheme.
This case is an example of the depth of investigative measures used by the government. Those that are the subject of such an investigation by the government should expect a thorough review of billing practices. It is likely the government will analyze every service and expense. As such, it is wise for those who are in this situation to act to protect their interests. Legal defenses are available, an attorney can help.