Allegations of healthcare fraud can do more than tarnish your professional reputation — they can lead to serious criminal penalties. In a recent example, the government accused a nurse practitioner and registered nurse of defrauding Medicare of over $10 million. The government claimed the medical professional billed for services that were never rendered and filled prescriptions for patients that he then went and sold for additional profit. They further claim that he illegally waived co-payments for Medicare patients to encourage the patients not to report fraudulent billing.
The government built a successful case for multiple healthcare fraud convictions. The court sentenced the nurse to seven years of incarceration, a $30,000 fine, and almost $12 million in mandatory restitution.
What happens in these cases?
The case generally begins with a tip to the government, or the government conducts an investigation after noticing some discrepancies in billing. Depending on the initial investigation results, the government may move forward and pursue criminal charges. If successful, they will likely encourage the court to move forward with a harsh sentence to provide an example to others.
Is this type of sentence common?
These harsh consequences are not uncommon. The case provides an example of the need to take such allegations seriously. They also raise questions about what rises to the level of a conviction or dismissal. This case had a couple of factors that weighed heavily in the government’s favor in support of a conviction and harsh penalty, including:
- History. The government states in the indictment that this was not the accused’s first “brush with the law” or his first time facing accusations of healthcare fraud. A history of similar offences can make the courts more likely to consider harsher penalties.
- “Ghost” office. The government also gathered evidence that the nurse used a secondary location solely for receiving mail to perpetuate the scheme.
- Billing discrepancies. Another key issue involved billing practices. The government provided evidence that billed services were impossible because the patient was out of the country at the time of the claimed service.
These factors highlight the importance of accurate record-keeping and the need to take a government investigation seriously. The officials that worked on the case repeatedly stated that the harsh sentence should serve as an example of the types of consequences that can come with healthcare fraud. As such, anyone that finds themselves a target of similar accusations should take the matter seriously.
Attorney John Rivas is responsible for this communication