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Three tips to avoid health care fraud allegations in NY

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:


  • Increased focus on opioids. The administration has made clear that it will focus on combating the nation’s opioid crisis. As such, those that prescribe, sell or distribute this drug will likely face increased scrutiny. This could include investigation by the soon to be formed Opioid Fraud and Abuse Detection Unit, a group that will specialize in over prescription of opioids and other forms of health care fraud involving the use of opioids.
  • Suspect billing codes. The government has also zeroed in on certain billing codes that it deems more likely to result in fraudulent claims than others. One example: billing codes that do not match up with the physician’s area of specialty. Another red flag, a discrepancy between the number of patients seen and the number of physicians available to provide services.
  • Questionable payments to patients or other medical professionals. The administration is also narrowing in on kickback violations. It is generally illegal to pay or offer other benefits to patients who seek your services. The penalties that come with a violation of the Anti-Kickback Statute are severe. As such, anyone accused of this crime should work promptly to build a defense. A physicians can use a safe harbor against these accusations, such as the use of referral services, to defeat the charges.

Health care providers can reduce the risk of a violation by addressing these common red flags. It is also wise to take action if your practice or organization becomes the subject of an investigation. Legal counsel can help defend your interests.


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