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What happens when the government accuses a doctor of healthcare fraud?

On Behalf of | Aug 31, 2022 | Health Care Investigations, Physicians & Physicians Groups |

The government continues its aggressive pursuit of those it believes abuse government funds. When the feds believe this type of situation exists, they investigate and, if possible, pursue criminal charges.

In a recent example, New York Attorney General Letitia James announced the indictment of a radiologist. According to the indictment, the physician ordered medically unnecessary tests including magnetic resonance imaging (MRI) tests of the spine and brain with contrast. This is invasive as it requires the injection of Gadolinium into the patient’s veins. The indictment further states that these tests were not ordered by the treating physician. The government also claims the physician had employees with his practice add codes and false information to increase reimbursement rates. The prosecution claims that these practices led the group to file fraudulent claims with Medicare.

The physician currently faces 13 felonies including Grand Larceny in the Third Degree, Health Care Fraud, and Falsifying Business Records.

What options does a physician have in this type of situation?

Those who face allegations of healthcare fraud are wise to take the matter seriously. If the government builds a successful case, the accused could face more than just a bill to cover the cost paid through claims to Medicare — they could lose their medical license, be barred from payment from insurers and face potential imprisonment.

Ideally, the first step when under investigation is to contact an attorney experienced in these matters. This legal professional can advocate for your interests and provide representation if the investigation moves forward to allegations of healthcare fraud. Potential defenses could include that the allegedly medically unnecessary tests that led to the claims were, in fact, necessary or that the government has insufficient evidence to build a successful case. An attorney experienced in healthcare fraud can review these and other defense strategies to better ensure a more favorable outcome.

Attorney John Rivas is responsible for this communication

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