Orthopedic practices, like any other medical specialty, can face allegations of health care fraud. The government pursues these allegations aggressively and, if successful, can request penalties that include millions in payment and potential jail time. Additional ramifications can destroy one’s medical career as the allegations can result in investigations from the medical board and loss of one’s medical license.
In can help to be familiar with some misconceptions common within the orthopedic field. Two common examples include:
Misconception #1: The government only prosecutes large cases.
There is a belief that government officials only pursue cases involving large hospitals and chains. Multiple recent cases prove this belief to be unfounded. In one example, an orthopedic surgeon was charged with violating the anti-kickback statute and accepting bribes from a pharmaceutical company, a spinal surgeon was sentenced to almost three years imprisonment for receiving illegal kickbacks and in another, executives of a relatively small orthopedic practice paid almost $6 million to settle claims of False Claims Act violations.
Misconception #2: Employees often fuel the charges.
The government often moves forward with a case based on information provided by current or former employees.
Qui tam, or whistleblower cases, often involve a former or current employee filing a claim on behalf of the government. Based on the details of the claim, the federal government may choose to respond. This can lead to an investigation by the Office of the Inspector General of the United States Department of Health and Human Services (HHS), Defense Criminal Investigative Service, Federal Bureau of Investigation (FBI) and other federal agencies depending on which insurance providers the suit implicates.