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TX uses new tool to charge doctors with health care fraud

The medical profession’s first concern should be the welfare of the patient. Most physicians, nurses and other medical professionals go into this field because they share a similar belief. However, as is true in any profession, there are some who stray and find the lure of financial rewards too much to ignore.

The government has various laws and regulations to help encourage a patient focus and deter financial motivation. One example is the Antikickback Statute. As a rule, those who practice must be very careful about financial partnerships with other physicians, hospitals or medical professionals. Although the partnership may have a focus on coordinated care efforts, the government could misconstrue the partnership as financially motivated and a violation of the Antikickback Statute.

The government is vigilant in investigation allegations of violations. In recent months, the investigations have expanded beyond Medicare recipients. Cases involving private insurance providers are becoming more common.

What has changed? Prosecutors have found a new approach, using the Travel Act to help support allegations of criminal activity. The law, passed in the sixties to crackdown on organized crime, makes it illegal to use the mail or other forms of interstate commerce in the commission of a crime.

How can prosecutors use a law made for the mafia against doctors? A case out of Dallas provides an example. The government went after a hospital that provided benefits for physicians that took positions within their facilities. In exchange for bringing their services, the hospital covered marketing expenses.

The prosecution used a rarely enforced state law to establish this partnership was a form of bribery. Once a crime was established, they could take it a step farther and apply the federal law against using commerce to market the physician’s services. The strategy was successful. The accused are now working on an appeal.

Will this change the practice of medicine in Texas? Critics of the prosecution’s aggressive technique in this case have called on the United States Department of Justice to provide guidance. Until then, the case provides an opportunity for hospitals and other medical providers to review their partnership agreements.