Authorities recently announced the sentencing of a registered nurse (RN) to 18 months imprisonment for her role in a health care fraud scheme. As part of the sentence, the court has also required the nurse to pay $9,500 in restitution.
What was the reason for the charges?
Earlier this year, government officials charged the nurse along with another RN and two physicians with crimes in connection to an alleged health care fraud scheme. The prosecution presented evidence to support allegations the group prescribed medically unnecessary compounded medications. Based on the evidence, the officials charged the RN with conspiracy to commit health care fraud and two counts of mail fraud.
What can others learn from this case?
This is one of many recent cases the government has pursued against those who prescribe compound medications. It appears the government believes the high reimbursement rate for these medications results in an increased likelihood of fraud. As a result, those who prescribe these types of medications are wise to review their practices to ensure they are not in violation of applicable regulations.
In this case, the government gathered and presented the court with evidence of payment agreements between medical providers that qualified as illegal kickbacks. Medical professionals in similar situations can reduce the risk of allegations of wrongdoing by keeping medical records to support the need for the prescription. It is also wise to carefully review payment agreements with other medical professionals, with a focus on potential Anti-Kickback Statute violations.
Those who are unsure of whether or not their practices are in line with these regulations are wise to seek legal counsel with experience in health care law to review their practices and provide guidance.