The government is serious about putting an end to healthcare fraud in the country and will aggressively pursue allegations of wrongdoing. They are especially fierce when those allegations come against someone who already has a prior conviction.
Recent example shows increased penalties that can come with a repeat offense
The case, out of the Southern District of New York, involves the prosecution of a surgeon for a repeated healthcare fraud offense. The government successfully prosecuted the physician for a previous fraud crime in 2013. As part of his punishment, he surrendered his license to practice medicine in the state. The prosecution claims that after giving up his license he began defrauding companies throughout the state using another surgeon’s credentials. He allegedly ceased operations when he went to prison for the first offense and began again upon his release.
The prosecution gathered evidence to support the claim, establishing that the accused used the other physician’s credentials to provide peer reviews for at least six medical peer review companies in the area. The prosecution claims he defrauded these companies of $876,389.97.
Upon review, the court not only agreed with the prosecution and moved forward with a conviction but also used the physician’s history to justify a more serious penalty. The court recently announced his sentence: almost ten years imprisonment and an additional three years of supervised release.
Court cases are just one option
This is just one example of the government’s efforts to crackdown on repeat offenders within the healthcare marketplace. They are taking a multi-faceted approach. Another facet the government uses is passage of rules through the US Centers for Medicare and Medicaid Services (CMS). A recent example is the passage of the Program Integrity Enhancements to the Provider Enrollment Process. This rule which allows authorities to bar individuals and organizations from Medicare enrollment if they have a past of affiliations with sanctioned entities.
This essentially means it can be difficult to get enrollment for even working with those who were previously denied or excluded from the programs, a potential penalty that can come with a conviction for healthcare fraud. This is part of an evolving plan that began in 2014 and could expand in the future.
Tips for those facing second or subsequent allegations
Penalties for a second or subsequent allegation are much more serious and it is important for those in this situation to handle them as such. Two tips that can help to ensure a more favorable outcome this time around include:
- Records. Have a process in place to keep clear and organized records to back up your decisions. This can help to build a case against the allegations.
- Compliance practices. It is also helpful to establish a compliance program to help rebut claims of wrongdoing.
It is also important to build a legal team to help better ensure your rights are protected from the investigation through potential litigation.
Attorney John Rivas is responsible for this communication
