Health care fraud cases generally follow the following timeline: the government becomes aware of a potential offense, an investigation occurs, and the government pursues criminal charges if the investigation leads to evidence to support the allegations. It may seem like a relatively straightforward process, but the reality can be circuitous and time consuming. A recent case provides an example.
New Jersey physician connected to health care fraud scheme
Although we do not know the details that triggered the government’s investigation, we know the government began looking into a group that prescribed allegedly medically unnecessary compounded medications. According to the indictment, the government claims to have gathered evidence to show that those involved with the alleged scheme would select the “most expensive medications with the highest number of refills to obtain the highest possible insurance reimbursement.” The investigators further claim the group would provide physicians with kickback payments in exchange for prescribing the medications, even though they allegedly never performed an exam to determine if the patient needed the compounded medication.
Ultimately, the investigation led to 33 criminal charges. These charges include conspiracy to commit health care fraud, wire fraud, giving false statements and illegal kickbacks.
After the indictment, the timeline continues
The accused then have two options: negotiate a plea deal or fight the charges. At this time in this case, at least four of the six accused individuals have chosen to accept a plea deal. The first, a physician’s assistant who pleaded to conspiracy to commit health care fraud. He faces up to 10 years imprisonment and $250,000 or twice the gross proceeds from the offense. The second and third, both physicians, pleaded to health care fraud and kickback charges. The fourth, a business owner, pleaded to health care fraud.
Determining which option is the best path depends on the details of each case. As a result, it is wise for those facing such allegations to seek legal counsel to discuss the options and tailor a defense to their specific situation.