The government takes allegations of fraud very seriously. If evidence is available to support the allegations, they will push for serious penalties. A recent case highlights the government’s aggressive approach in these cases. The government accused the doctor of prescribing durable medical equipment and completing genetic cancer testing without seeing or treating the patients. They argued the physician’s actions were motivated only by financial gain, not by the well-being of the patients.
The prosecution was able to gather evidence to support the allegations, which included copies of medical orders and claim submissions. Upon review of the evidence, the physician agreed to a plea deal, pleading guilty to conspiracy to commit wire fraud. He recently faced sentencing, and the court sentenced him to more than 10 years imprisonment and $34 million in restitution payments. These harsh penalties should serve as a stark reminder of the seriousness of a health care fraud investigation. Physicians should use this as an opportunity to learn more about the process and how to protect themselves from facing similar allegations.
How does an investigation into Medicare fraud proceed?
An investigation into Medicare fraud typically begins with an initial inquiry, often triggered by a whistleblower or audit findings. Depending on the findings of this initial review, the team may move forward with an in-depth investigation. This is generally conducted by entities such as the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), and the Department of Justice (DOJ).
Those conducting the investigation will review billing records, patient records, and correspondence for evidence of wrongdoing. This can result in charges, often including conspiracy to commit health care fraud, health care fraud, money laundering, and wire fraud.
What are the potential penalties if convicted of health care fraud?
The penalties for Medicare fraud often include:
- Financial fines: Can be substantial, often multiple times the amount of the fraudulent claim.
- Imprisonment: Serious cases may lead to imprisonment.
- Professional consequences: Including the possible suspension or revocation of medical licenses.
As noted in the example above, authorities will pursue prison time and hefty financial penalties.
What are common defense strategies?
Physicians who find themselves under investigation or facing charges are wise to gather and organize documents related to the case. These cases also often utilize professional witnesses to provide insights that challenge the prosecution’s claims.
Physicians facing Medicare fraud allegations are wise to take the matter seriously. In addition to learning the basics of the progression of the case and common defense strategies, it is also wise to seek legal counsel who is familiar with this area of law. An attorney with experience in health care law can review the allegations and tailor a defense strategy to the specifics of your case, better ensuring a more favorable outcome.
Attorney John Rivas is responsible for this communication.