Allegations of health care fraud are serious. Savvy professionals in the health care industry realize that a conviction can mean more than just a steep fine. Depending on the details, a conviction can result in jail time and the loss of professional licensure. A recent nationwide takedown provides an important lesson for those who work in this field: how you bill for services matters.
What was the takedown?
The health care fraud takedown is record-setting, nationwide effort that led to charges against 322 individuals, dozens from Texas. Charges were levied against various professionals, including:
- Business owners: The prosecution has accused multiple business owners of charging Medicare and Medicaid for hospice services when the patients did not meet the required definition for terminally ill.
- Pharmacist: The agency has also filed charges for unlawful distribution of controlled substances against a pharmacist, claiming he took illegitimate prescriptions from his pharmacy and provided them to patients without a legitimate medical purpose.
- Podiatrist: The prosecution also claims a podiatrist billed Medicare for skin substitute products when patients did not have qualifying wounds.
The prosecution has built these charges on the fact that the accused failed to meet applicable definitions to justify charging Medicare and Medicaid. This serves as a reminder of the importance of making sure billing practices meet these strict criteria.
How can I mitigate the risk of similar charges?
It is important to conduct regular internal audits to check for compliance with federal regulations such as the False Claims Act, the Anti-Kickback Statute, and the Stark Law. It is also wise to develop and maintain clear, written policies and procedures that outline compliant billing practices. For some, use of advanced billing software can help automate compliance checks and reduce human error.
By adopting these strategies, healthcare professionals can create a robust compliance framework that minimizes the risk of fraud allegations and better ensures adherence to federal regulations.
Attorney John Rivas is responsible for this communication.