The United States Department of Justice’s U.S. Attorney’s Office District of New Jersey recently published a news release claiming a New York man defrauded a health benefit fund of over $4 million. The feds claim the man was part of an intricate healthcare fraud scheme that involved the use of health fairs to conduct as many medically unnecessary tests as possible. The group would then bill the union fund for these tests.
Fraud or preventative medicine? Aren’t health fairs a good thing?
Various healthcare organizations and private practices throughout the country conduct health fairs. These fairs are generally beneficial for the communities as they often provide an opportunity for preventative care and screening tests, potentially flagging diseases and injuries that may require further treatment before they become too difficult to manage.
So what went wrong here? According to the feds, the group running the fairs bribed health care officials and pressured and paid medical professionals to perform “as many tests on union members of possible” whether they were medically necessary or not — a very serious allegation if the feds can provide evidence to support the claim.
The feds also state the group lied about where medical professionals conducted the testing. The prosecution states the group filled out claims for payment stating the tests occurred at a physician’s office or urgent care facility. This alleged deception helped the feds to build their case.
What can those who run health fairs learn from this case?
Transparency is a good thing. So is medical necessity. Those behind this alleged scheme currently face up to 10 years imprisonment and a fine of $250,000 or twice the gross gain from their offense. Since they are accused of bilking the union of $4 million, this fine could be astronomical.
Those who are putting together health fairs are wise to do so carefully. Remember, you are likely billing a government entity or health insurance provider for the services rendered at the fair, so make sure you are in line with the expectations that come with these claims.