The government recently accused three physicians out of Long Island for taking part in a health care fraud scheme that cost the Medicare and Medicaid program approximately $163 million in fraudulent charges. The physicians were investigated by many government agencies, including the Justice Department (DOJ), Internal Revenue Service (IRS), Federal Bureau of Investigation (FBI) and the New York State Office of the Medicaid Inspector General.
What were the accusations? The physicians purportedly provided unnecessary physical therapy sessions and other services to Medicare eligible participants. Officials have also accused one of the physicians, a podiatrist, with false claims for skin graft and wound packing treatments. The government states the physicians would either provide medically unnecessary services to patients or charge for treatments that the patients did not receive.
What are the charges? The physicians face a number of criminal charges, including:
- Conspiracy to commit health care fraud
- Conspiracy to commit money laundering
- Conspiracy to pay health care kickbacks
- Conspiracy to defraud the United States through obstruction of the functions of the IRS
- Filing false and fraudulent tax returns
These charges can come with monetary fines and potential imprisonment.
Are these investigations common? It is not uncommon for many government agencies like the FBI and IRS to work together to investigate allegations of health care fraud. These charges are part of a national investigation that has resulted in over 600 individuals facing health care fraud charges. In addition to physicians of various specialties, the DOJ has also charged nurses, pharmacists and other medical professionals with criminal health care fraud as a result of this larger investigative effort.