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Politician pleads guilty in health care fraud case

Medical professionals are not the only ones that can face allegations of health care fraud. A recent case out of Alabama provides an example of a politician that found himself the focus of a federal investigation. 

What led to the investigation? The investigations began when a member of the lawmaker’s staff accused the politician of having an affair with another staffer. This allegation resulted in his resignation, but also triggered an additional investigation.

During the first investigation, federal officers who were conducting pill-mill operation investigations investigated a business owned by the politician. This resulted in the discovery of documents that showed allegedly illegal operations.

What were the allegations? Based on this evidence, the government accused the politician of working with medical doctors to waive co-pays for Medicare patients who received treatment at his medical facility.

The facility provided care-coordination calls to help manage the patient’s medical care needs. The prosecution states the accused used the waivers to encourage patients to receive these services — services they would likely have turned down if they were required to pay the copay.

What are the penalties? The criminal charges can come with up to ten years imprisonment. However, since the former lawmaker took a plea deal and plead guilty to the allegations earlier this week, he faces a reduced sentence. The prosecution has agreed to ask the court for the lowest recommended prison sentence and fine.

The case serves as a reminder that anyone associated with a medical business could find themselves the subject of a health care fraud charges. Those who are under investigation are wise to act to protect their interests. An attorney can help.