The United States Department of Justice (DOJ) recently accused a group of 10 individuals of partaking in a health care fraud scheme that cost the government over $1 billion. The accused include hospital executives and diagnostic lab owners as well as billers.
According to the government, the group perpetrated a health care fraud scheme by taking over rural hospitals and using these small hospitals to bill private insurance companies for urine and blood tests. The government argues the billers would claim the testing was completed within the rural hospital when in actuality it was completed using outside labs. this, the prosecution claims, allowed the group to use rural hospitals as a type of shell company to illegally bill insurance providers. The government pursued two claims against this practice. First, that the group was using illegal billing practices to inflate reimbursement rates. Second, that many of the tests were not medically necessary.
Based on this information, the government states the group used questionable billing practices to receive fraudulent reimbursements for their own financial gain. As a result, the DOJ charged each of the accused with one count of conspiracy to commit health care fraud and one count of wire fraud. Prosecutors chose to charge some involved in the alleged scheme with additional crimes, such as money laundering. If convicted, these charges can result in high financial penalties as well as potential imprisonment.
As noted above, if the government can establish these claims the accused can face serious penalties. As a result, those who are under an investigation for similar allegations are wise to take the process seriously. An attorney experienced in these types of claims can review the investigation and the allegations and provide guidance.