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3 key pieces of evidence used to support healthcare fraud case

A recent healthcare fraud case out of New York, New Jersey and Pennsylvania involves two physicians and multiple other individuals who allegedly used illegal kickback payments to conduct and bill Medicare for unnecessary genetic testing. The government claims to have multiple pieces of evidence to support the claims, including:

  • Test frequency reflecting kickback schedule. The prosecution claims the number of genetic tests ordered dropped when the kickback payments stopped. The evidence also shows a connection between receiving payment and an increased frequency of testing.
  • Money trail. The government also states they have records of the kickback payments made to the physicians from the labs through cell phone money-transfers and wire payments.
  • Recordings. The government also states it has recordings of the accused making statements related to the alleged bribes.

The government also claims at least one of the physicians implicated in the crime discussed expanding the scheme by adding in unnecessary cancer screening tests. The alleged scheme would focus on providing cancer screening tests to Medicare patients. The physician would order the tests from the lab and the lab would provide payments to the physician in return for using their services.

If the government can support these claims and successfully pursue a conviction for a federal anti-kickback statute violation, they face up to five years imprisonment and $250,000 in fines or half the proceeds from the scheme, whichever is greater.

What can others facing similar charges learn from this case?

If the government is concerned about healthcare fraud, it will conduct a thorough investigation. Those who believe they are under investigation are wise to promptly seek legal counsel to discuss their options and begin building a defense to the allegations.