The federal government, along with state and local authorities throughout the nation, have made it clear that they intend to continue their crackdown on illegal healthcare fraud. Although the goal is noble, these broad and sweeping statements can result in overly aggressive investigation tactics and false allegations of wrongdoing.
Anyone who bills Medicare or Medicaid for services rendered to patients is wise to take the announcement seriously. Allegations of fraudulent claims that result in payment from Medicare, Medicaid, or other government providers can come with harsh penalties. Three common examples include the following.
#1: Financial penalties
The government recently settled a healthcare fraud case with a nephrologist accused of accepting financial inducements, or illegal kickbacks, from a lab in exchange for use of their services. Allegations of a violation of the Anti-Kickback Statute (AKS) can take many forms. In this case, the government claimed the physician received bribes through provision of office space rental, “free” clinical staff to help run his clinic, and thousands of dollars in consulting fees.
When faced with the allegations, the physician agreed to pay the government $585,540 to settle the claim.
The Justice Department charged over 75 individuals in connection with an alleged healthcare fraud and opioid abuse scheme. The case involved various allegations of wrongdoing including healthcare and prescription fraud. In a related case, the court sentenced a participant to 15 years imprisonment for their role in the scheme.
#3: Loss of medical or professional license
Allegations of wrongdoing often trigger an investigation by the state licensing board. This can result in sanctions against one’s professional license which can include suspension and revocation — making it seemingly impossible to continue in one’s chosen profession.
Allegations of wrongdoing are just the beginning. You can fight back. Because the stakes are high it is wise to seek legal counsel from an attorney experienced in this niche area of the law.
Attorney John Rivas is responsible for this communication.