The United States Department of Justice (DOJ) recently announced it will pursue health care fraud charges against 6 physical therapists (PTs) and 2 acupuncturists who run facilities in New York. The feds claim the professionals developed a multi-million-dollar health care fraud scheme that spanned three years and improperly billed Medicare for services they never provided.
The prosecution claimed to have evidence the health care providers put together false medical documentation to support the claims. The feds also state they have records of illegal kickbacks to patients in exchange for providing insurance information. These kickbacks allegedly included cash payments, and expensive gifts of wine.
Those involved now face charges of conspiracy to commit health care fraud, conspiracy to violate the federal Anti-Kickback Statute, conspiracy to commit money laundering, wire fraud and theft of government funds. These charges could lead to over 75 years imprisonment.
The accused are currently in negotiations with the prosecution. They could either attempt to negotiate a deal with the government or fight the charges in court.
The case provides an example of the severity of penalties that can accompany allegations of poor billing practices. A failure to correctly bill Medicare and other insurers can trigger an investigation, such as this, and lead to dire consequences.
There are two primary lessons from this case:
- The importance of compliance. This cannot be overstressed. It can help to conduct regular internal audits and adjust as needed to better ensure compliance.
- The seriousness of an investigation. A government investigation into billing practices is not something to take lightly. It can lead to these types of allegations.
It is possible to delegate these matters so you can focus on your practice — the important lesson is that you address these issues to protect your interests.
Attorney John Rivas is responsible for this communication.