A doctor at a Veterans Affairs (VA) hospital in New York faces multiple criminal charges for alleged criminal conduct in 2016. Doctor Jerome F. Cuyler worked with service members that were part of the Integrated Disability Evaluation System during the time of the accusations.
The VA fired the 74 year-old physician as a result of these charges.
The Department of Justice and the United States Department of Health and Human Services (HHS) have made it clear that the government is cracking down on healthcare fraud. To help illustrate this point, the agencies conducted the largest healthcare fraud enforcement action in history.
The HHS and DOJ conducted the enforcement action in July of 2017. It resulted in criminal charges for 412 individuals. This included 115 medical professionals such as doctors and nurses for a number of criminal charges, including allegations of false billings.
Two anesthesia providers and two orthopedic surgery providers agreed to settle with the Department of Justice over claims of illegal kickbacks and submission of false claims to Medicare.
The investigation into the claims was the result of a whistleblower case. The False Claims Act includes a provision which allows employees to voice concerns about wrongdoing without fear of professional retaliation. A former administrator within one of the practices filed suit on behalf of the United States based on this qui tam provision of the False Calms Act. In exchange for bringing forward the suit, the private citizen stands to receive a portion of the settlement.
A nurse in Wisconsin is facing allegations of abuse while working in the neonatal intensive care unit (NICU). The allegations led to an investigation of the nurse. Alleged abuses include bruises to the arms of infants and a skull fracture.
The nurse’s license is currently suspended.
The current administration is working hard to combat health care fraud. Health care providers can reduce the risk of becoming the subject of an investigation into this type of crime by avoiding what are referred to as the common “badges of fraud.”
A recent piece in the New York Law Journal discussed these badges, noting three of the more common red flags include:
The Office of the Inspector General (OIG) recently reported that the Medicaid fraud control units (MFCUs) secured 1157 fraud convictions. The MFCU investigates those accused of Medicaid fraud.
What leads to an investigation by an MFCU? The investigations are generally initiated by referrals or complaints made to the organization. Data mining can also provide a means to conduct an investigation.
A 59 year-old cardiologist faces larceny and criminal possession of a controlled substance charges in New York. Local police and the Medicaid Fraud Control Unit investigated the physician and accuse him of stealing hydrocodone pills and other medications from patients.
New York’s Attorney General’s Office has not stated whether or not the physician will face prosecution for these alleged crimes.
Allegations of health care fraud can cause serious harm to a health care provider’s reputation. As such, it is not surprising that those who find themselves the subject of an investigation or face accusations of this form of fraud seriously consider accepting a settlement agreement in the hopes that they can move on with business and put the whole ordeal in the past.
Unfortunately, accepting a settlement agreement does not always allow for the accused to move on with his or her practice.
The Federal Bureau of Investigations (FBI) continues to crack down on allegations of billing fraud within medical practices. The agency provided an example of increased enforcement efforts with a recent raid of an office in New York.
What was this investigation about? The federal agency dug into the paperwork of a medical practice in Western New York. It was looking for billing discrepancies. In some cases, these discrepancies can result in allegations of fraud. This is the case for this specific investigation.
New York recently passed a law that changes the requirements needed to earn a nursing license. The law achieves two goals: creates a commission to review the nursing profession and increases the requirements tied to the license.
Creation of a commission
The law creates a temporary nursing program evaluation commission. The group will review what types of barriers are present that keep candidates from entering the nursing profession. The group will report to the governor after 12 months of research.
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