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HHS completes largest healthcare fraud enforcement in history

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.

Takedown just one large event amongst many smaller prosecutions

The government’s healthcare fraud prevention and enforcement efforts were responsible for convictions in many areas, not just the false billings charges that resulted from the massive effort noted above.

The agency notes the five most common criminal charges that resulted from investigations included medical professionals that were found to operate “pill mills” from their offices, false Medicare claims for ambulance transportation services, false physical and occupational services claims to Medicare, kickbacks to physicians for prescribing medications and misrepresentation of electronic health record software capabilities.

Criminal penalties are just one repercussion. A conviction can also result in exclusion from future participation in federal programs, like Medicare.

This outlines the two main forms of penalties the HHS pursues against those accused of healthcare fraud crimes. The agency pursues criminal penalties that often result in hefty payments as well as future repercussions, like the inability of the practitioner to partake in Medicare and Medicaid programs. As such, a conviction of a healthcare fraud crime can ruin a medical professional’s career. This risk can be mitigated with by building a defense to the charges.

HHS efforts for future prosecutions

The agency also announced the formation of the Opioid Fraud and Abuse Detection Unit. It will “combat and prosecute individuals and entities involved in illegal activities that fuel the [opioid] crisis.” This means the agency has increased its focus on allegations of physicians running pill mills or pharmacies that are diverting prescription opioids for illegal activities.

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