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Accused of health care fraud? Cross examination is a powerful defense tool.

Those who face allegations of health care fraud can find themselves fighting an uphill battle. The government can gather evidence and witnesses to testify against you, but defensive strategies are available to help you defend your professional reputation. One strategy to use during a health care fraud trial: cross examination.

A recent case provides an example. In this case, the United States government accused a rheumatologist of health care fraud. As part of their case, the government called former employees of the rheumatologist to testify. One of their key witnesses, a rheumatologist who worked for the owner, made the following accusations:

  • High volume of patients. The worker told the government the accused asked her to see a large number of patients, sometimes up to 30 per day.
  • Lack of interaction with owner. She claimed the owner would generally conduct the initial appointment with patients but would require other workers to conduct the majority of follow-up appointments.
  • Questionable diagnosis. She stated the accused would provide multiple diagnosis not often found in a single patient.

The government then used evidence of these allegedly questionable diagnoses, as well as allegations the accused ordered questionable and potentially medically unnecessary tests, to support charges the owner was filing fraudulent claims for reimbursement from his patients' health care insurance providers.

Accused builds a defense to the allegations

The accused used the opportunity for cross examination to defend against these allegations. The rheumatologist had not worked for the owner for over 13 years and had only spent three years working at his clinic. The owner also noted the rheumatologist witness had filed a complaint during her time at his arthritis and osteoporosis center. This complaint did not include any concerns about false diagnosis or billing concerns. Her only written concern was that a primary care physician should have ordered the tests instead of a rheumatologist.

The accused also challenged the notion that 30 patients were too many. Other witnesses testified there were many in need of care, and this did not seem like a concerning number of patient visits.

Lessons for others from this case

The trial is ongoing. We will provide an update on the outcome of the trial when it is available. However, the case highlights the need to cross-examine witnesses called by the government, an important legal tactic to help build a defense to the charges.

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