The United States Department of Justice (DOJ) recently released the details of an indictment against a New York physician charged with millions in healthcare fraud. According to the feds, the physician only took a few minutes conversing with patients before moving forward with prescriptions and medical care. The government argues that this was not long enough to make decisions that were medically necessary for the patient and that his billing of government programs like Medicare constituted healthcare fraud.
The government further claims to have evidence of illegal kickbacks to support these allegations. They state the physician received financial compensation in exchange for using a specific orthopedic brace to treat these patients’ ailments.
Part of a bigger trend?
This is not the first of this type of case. The DOJ has moved forward with dozens of similar cases in recent years, potentially establishing a trend where the feds appear to target telehealth providers for allegedly defrauding the government by not getting enough information to support chosen treatment.
What can physicians learn from these cases?
The government is looking at medical necessity, hard. Make sure to have records to support medical decisions. This will help to counter any claims of wrongdoing if the government comes after you in the future.
If the government does investigate your practice, take it seriously. These allegations can come with serious penalties. In the case noted above, the surgeon faces up to 10 years imprisonment — but those in this situation do not have to simply accept the government’s findings. Defenses to these allegations are available. The government’s charges can be countered by a number of different legal strategies including medical records that support your decisions. The right strategy will depend on the details of the case but know that you have options.
Attorney John Rivas is responsible for this communication