Health care fraud is a broad term used to encompass different allegations of criminal activity. The types of allegations the government commonly prosecutes for health care fraud can vary year to year.
This piece will touch on recent trends and provide some examples to help illustrate the steep penalties that come with a conviction.
Trend #1: Opioids.
Pain management, particularly the use of opioids, is under scrutiny by the government. Any use of prescription medication that does not serve a medical need will face scrutiny and can result in allegations of fraud. If substantiated, the allegations can result in hefty financial penalties as well as prison time.
In 2017, the government built a successful case against a doctor for illegally prescribing oxycodone, hydrocodone and other controlled substances. The physicians were sentenced to 19 years imprisonment.
Trend #2: Illegal bribes.
This one is particularly tricky. Having professional relationships with others in the field can serve the patient’s best interest. However, the government will analyze these relationships to ensure they follow applicable regulations. A failure to do so can result in allegations of Stark Law and Anti-Kickback Statute violations.
Novartis Pharmaceuticals Corp. recently announced it will set aside over $700 million to settle allegations it made illegal kickback payments to encourage physicians to prescribe their medications.
Trend #3: Unnecessary medical treatment.
Physicians and other medical professionals must be able to explain a medical need for any treatment that is then billed to Medicare or Medicaid. Billing for unnecessary treatments is fraudulent and will likely result in prosecution.