Health Care Fraud has been a focus of federal prosecutors across the country. In recent years, the prosecutions for federal health care fraud cases has increased tremendously. This is because with the cost of healthcare rising tremendously in the last decade, the amount of money being paid by the federal government is rising as well. Early on, healthcare fraud amounted to false billing by medical professionals. Recently, the range of offenses the federal government has considered fraudulent has grown. Below are listed some new areas related to healthcare fraud.
- Hot Enforcement Areas
- Home Health
- Off label marketing
- Paying for patients/referrals
- Mental health
- Cardiac surgery
- Foreign Corrupt Practices Act in Pharmaceutical & Medical Device
- Manufacturing Issues
- Prescription Drug Diversion/Pain Management doctors
As a result of these new areas of health care fraud investigations, the Drug Enforcement Agency has doubled their staff and are now much more stringent on enforcing and prosecuting loss and theft related to healthcare.
In addition, federal prosecutors are investigating the following:
- Lack of Medical Necessity
- Fraud in Clinical Trial settings and falsifying clinical data
- Heart Procedures involving the use of stents and unnecessary cardiac catheters
- Defective implant cases
Individuals who are oftentimes the targets of federal investigations are growing as well and do not only include doctors anymore. Other individuals who are targets include:
- Providers such as Medical directors, Owners of facilities, Office managers, Service providers and Referring doctors.
- Manufacturers including upper management
The investigations and cases continue throughout the country. Companies keep getting hit. For example, Ranbaxy paid $500 million (criminal and civil manufacturing case), Wyeth plead guilty and paid $490 million.
Federal prosecutors charge for upcoding, length of stay cases, and unnecessary treatments.
A strong defense to Healthcare Fraud charges include combating the increased use of undercover techniques against targeting individuals, CMS (center for medicare/Medicaid services) cutting off reimbursements to corporate employers, CMS using their leverage over corporate employer to make joint defense tricky, cases are expensive to defend and increasingly technical with sophisticated billing techniques.
Finally, with the consequences of healthcare fraud cases being so great it is crucial that those that are targets of federal investigations and those individuals who have already been charged by the federal prosecutors with fraud defend themselves vigorously. In addition to prison sentences and hefty fines, those convicted to healthcare fraud face additional penalties such as the loss of license and exclusion from medicare program.
If you or a loved one has been charged with health care fraud, contact the Law Office of Purav Bhatt to discuss your options and begin mounting a defense. Contact us at 773-791-9682.