A recent case out of New York provides multiple examples of what not to do if accused of health care fraud. The case began when the U.S. Attorney’s Office of the Western District of New York investigated a psychiatric physician for health care fraud. According to the prosecution, the physician billed for the highest level of evaluation appointments when seeing new patients. When questioned about the need for such an inclusive appointment, the government claims he was unable to provide sufficient evidence to support the claim. Upon further investigation, the government claims the physician routinely up coded and improperly billed for services.
The government also claims the physician’s claim as board certified in Psychiatry were false. In fact, they stated he used his own personal computer to fraudulently put together a certificate – which he allegedly provided to the government to support his claim. When presented with the evidence, the physician chose to accept a plea deal.
Three important lessons from this case include:
- Do not skimp on notes. It is important for physicians to take enough notes to justify the service they are claiming to provide their patients.
- Do not attempt to forge documents. The government has access to tools to check the validity of certificates. Do not make false claims and attempt to back them up with fake documents. This will only lead to additional allegations of wrongdoing.
- Do not go it alone. You have options. Legal counsel can help.
An attorney experienced in the niche area of health care fraud can review the allegations and tailor a defense to your specific case. As a result, seeking legal counsel can better ensure your interests are protected.