Aggressive Federal Targeting of Medical Fraud Likely to Rise

According to a new report from MD News, 2014 saw a significant rise in federal action against medical fraud and abuse perpetrated by physicians. The trend represents the FBI and Department of Justice's renewed focus in targeting both physicians and large healthcare organizations and is expected to continue to rise for the next few years.

When it comes to investigating and reprimanding physicians, violations of the Stark Law, the Anti-Kickback Statute, and the False Claims Act are the most common. If convictions are reached, these charges can result in fines, forfeitures, and even prison time. MD News profiled three recent cases demonstrating the federal government's aggressive pursuit of these cases:

  • In May, two physicians were sentenced to 37 months and in prison and numerous fines for accepting bribes in exchange for referrals to a specific clinical lab. The Department Justice revealed that their prosecution was part of a larger bribery sting that has resulted in the recovery of more than $10 million in forfeiture.
  • Last October, two cardiologists agreed to settle allegations that they violated the False Claims Act by paying $380,000. According to the DOJ, they had been entering into false management agreements with a hospital in exchange for referring patients to that facility.
  • One month later, a physician pleaded guilty to his critical role in a $19 million home healthcare scheme. According to authorities, he allegedly accepted kickbacks from home healthcare agency owners for referring patients-some of whom did not qualify for or even need home healthcare-to those agencies.

A Time to Evaluate Protocols

All signs point to increased federal vigilance for physicians engaged in fraudulent activity to continue and even intensify in 2015 and beyond. As MD News notes, a U.S. Attorney for the District of Kentucky, who had been involved in the cardiologist case, stated in a press release: "We will continue to use all the tools available to us to safeguard our federally funded healthcare programs from those who seek to profit from them through illegal means."

In this kind of climate, it is especially important for medical professionals to review their arrangements with healthcare providers and ensure that the terms of those agreements are in compliance with best practices. These matters are usually dense and complex, but if violations are found, even unsuspecting doctors and other professionals can be charged.

If you are currently dealing with a Stark Law, Anti-Kickback Statute or False Claims Act violation, then the time to speak with legal counsel is now. At The Law Offices of Alejandro Mora, PLLC, we exclusively deal with healthcare law. Our Texas healthcare administrator attorney has been defending the rights and interests of medical professionals for over a decade and ensures our clients receive every administrative consideration.

Retain a proven advocate to see you through this uncertain time. Contact our firm today.

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