The United States Department of Justice (DOJ) recently announced criminal charges against the owner of a home health services business of over $100 million in healthcare fraud. The charges include money laundering, health care fraud and conspiracy to pay and receive kickbacks.
What types of penalties come with healthcare fraud charges?
The charges come with serious penalties. If convicted, a healthcare fraud charge can come with up to 10 years imprisonment and a $250,000 fine. The kickback charge can come with five years in prison and another $250,000 fine.
Based on these two charges alone, the entrepreneur faces up to 15 years imprisonment and half a million in fines. And that’s not the end of it. The government is also seeking forfeiture of five properties, multiple bank accounts and investments.
How do the feds build these types of cases?
These cases generally involve multiple agencies working together to gather evidence to support the allegations. The investigation may begin after a disgruntled employee files a complaint with the government in the hopes of building a whistleblower suit, or government software may flag claims your group made with Medicare, Medicaid, or another organization as suspicious.
With this case, the government claims to have gathered evidence of the following to support the allegations:
- Failure to train staff.
- Billing for medically unnecessary services.
- Billing for services that were never provided.
These are common examples of the types of evidence they use to build these cases.
What can my home health agency do to avoid similar allegations?
Education is important. Have a basic understanding of the applicable regulations and make sure everyone within your practice is also aware of these rules. It is also helpful to conduct regular internal audits. These reviews allow leadership the chance to look into any potential problems and make changes before the issues grow into a violation.