The government recently accused a Texas woman of partaking in a health care fraud scheme that took place in Arkansas. The woman allegedly used her role recruiting patients for a company that marketed prescription medications for a Mississippi pharmacy.
Health care fraud is a broad term used to encompass different allegations of criminal activity. The types of allegations the government commonly prosecutes for health care fraud can vary year to year.
The medical profession's first concern should be the welfare of the patient. Most physicians, nurses and other medical professionals go into this field because they share a similar belief. However, as is true in any profession, there are some who stray and find the lure of financial rewards too much to ignore.
The Centers for Medicare and Medicaid Services (CMS) take violations to healthcare laws very seriously. A conviction can come with hefty penalties that may include exclusion from federal healthcare programs, fines and, in severe cases, imprisonment.
A trial this week involving the once-celebrated Dallas-based Forest Park Medical Center is said to be one of the biggest health care fraud trials in history. There are as many as 150 witnesses as part of the government's case against ten defendants, which include four surgeons and one pain doctor.
Lawmakers often pass or change laws with good intentions. In some cases, those intentions may not translate in the real world. An attempt to thwart wrongdoing can result in an unnecessarily confining situation.
The government is working to transform our healthcare system into one that pays for value. The Health and Human Services Department (HHS) recognizes that care coordination is an important tool to meeting this goal. However, the government has also recognized physicians and other medical professionals abused this system with the use of kickbacks solely intended for financial gain. To thwart such abuse, the government had previously passed Anti-Kickback laws.
The False Claims Act is a federal law that allows the government or private individuals to file a claim against those who allegedly make false claims for payment against the United States. It is common for an individual to file suit and the government to join in at a later date. These cases can include physicians and health care providers that charge Medicare or Medicaid for services provided to patients.
Texas-based EmCare doctors "provide emergency medicine, hospital medicine, general and trauma surgery, anesthesiology and radiology/teleradiology care to hundreds of hospitals and healthcare facilities throughout the country," the company says on its website. It is perhaps unsurprising that the Dallas firm makes no mention of its recent agreement with the U.S. Department of Justice to settle claims that it engaged in health care fraud.
United Therapeutics Corporation (UT), based in Maryland, has just agreed to settle Anti-Kickback Statute and False Claims Act allegations for $210 million. The drug maker has also entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.