If the government is to be believed, the United States healthcare sector is plagued with fraud. And both federal and state authorities are cracking down on it. Simple billing errors by doctors or nurses (even if inadvertent) or misused prescriptions by pharmacists or patients (even without any genuinely nefarious intent) could result in criminal charges and land you in a courtroom. Fortunately, an experienced health care fraud lawyer can help you to head-off the filing of criminal charges before the government acts so that you can maintain your professional standing or, if charges are filed, help to you clear your name.
At Protass Law PLLC, we excel in achieving positive resolutions for our clients in complex, high-stakes criminal, regulatory and administrative cases. Our unwavering focus on our clients’ interests, and our results-oriented approach, enables us to effectively advocate at every stage of the litigation process — from investigation through trial and, if necessary, at sentencing. The earlier we can begin assisting you, the more we will be able to do for you. Call us today at 212.455.0335 or use our online contact form to schedule a consultation.
Federal Health Care Investigators Analyze Billing Data to Uncover Fraud
The Medicare Fraud Strike Force (MFSF) is a multi-agency team of federal, state and local investigators and prosecutors who are working overtime to combat Medicare/Medicaid fraud. Launched in 2007, the MFSF is coordinated by the U.S. Department of Justice and the U.S. Department of Health and Human Services. It combines the data-analysis capabilities of the Centers for Medicare and Medicaid Services, the investigative resources of the FBI and the prosecutorial resources of the DOJ and local U.S. Attorney’s Offices as well as state Attorneys General and local District Attorneys. Since its inception, the MFSF has brought charges against approximately 4,000 individuals, accusing them of having engaged in Medicare/Medicaid frauds purportedly causing losses in excess of $16 billion.
The MFSF has 15 regional strike forces that operate within 24 federal judicial districts that comprise the entire nation. In late 2019 alone, the MFSF brought the following cases:
- Indiana–On October 4, 2019 two healthcare workers were sentenced to several months in prison each (and ordered to pay $757,499.06 in restitution) for having submitted false Medicare/Medicaid claims for unauthorized ambulance rides — that is, ambulance rides for patients who were ineligible for government-funded medical transportation.
- New Jersey–On October 3, 2019 the government charged five healthcare professionals with allegedly having submitted $4.5 million of fraudulent claims for medically unnecessary prescriptions (including charges of wire fraud and making false statements to federal investigators).
- Louisiana and Georgia–Between September 27 and October 1, 2019 the DOJ charged dozens of individuals for their participation in a scheme to solicit medically unnecessary cancer genetic tests (GGx). The tests were approved by doctors who were not treating the patients for whom the tests were prescribed. The testing laboratories, in turn, received kickbacks for submitting Medicare/Medicaid claims for the tests they performed and even for tests that were never performed. One of the largest healthcare fraud cases in history, the government estimates that more than $2.1 billion in false Medicare/Medicaid claims were submitted for reimbursement.
- Pennsylvania—On September 6, 2019 prosecutors in the Eastern District of Pennsylvania leveled charges against five Philadelphia-based physicians and other healthcare workers for allegedly having run a $4 million prescription drug fraud scheme that caused more than 700,000 highly addictive oxycodone pills to hit the streets. Those alleged perpetrators’ scheme was purportedly a part of a larger organization spanning multiple northeastern states, involving $800 million of fraudulent Medicaid/Medicaid claims and the distribution of over 3.25 million such pills.
Every week the DOJ announces new charges against or convictions of healthcare professionals who are alleged to have defrauded the Medicare or Medicaid systems. The regularity of those announcements demonstrates that the MFSF is active, effective and efficient in investigating and bringing healthcare-related criminal charges nationwide. If you are a healthcare professional, you should know that any billing irregularities in your clinic, laboratory, hospital or small practice could well come under scrutiny and, if serious enough, could result in life-altering criminal charges.
How a New York Healthcare Fraud Lawyer Can Help
To obtain a conviction for healthcare fraud, the government must prove beyond a reasonable doubt that you deliberately made misstatements or omissions of material fact with the intent of profiting from other people’s belief in your statements. Proving such “intent,” though, is often difficult. And the absence of “intent” is often at the core of any defense against healthcare fraud charges, such as arguing that what the government characterizes as deliberate fraud amounts only to innocent billing errors.
The sooner you call a lawyer, the sooner they can begin developing a defense strategy for you. As your case proceeds through the system, your options for defeating (or mitigating) the charges will diminish. So, if you are a healthcare professional – whether a physician, nurse, pharmacist, independent diagnostic testing facility (IDTF) or otherwise work in the healthcare field – and if you have any inkling that the government is looking at or examining your work or billings, the time to contact an attorney is now. To schedule your consultation with New York criminal defense lawyer Harlan Protass, call 212.455.0335 today.