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Can business executives go to prison for healthcare fraud?

On Behalf of | Aug 31, 2023 | Health Care Investigations, Stark Law/Anti-Kickback Statutes |

Healthcare fraud sounds like the kind of crime committed by a physician or nurse who conducts unscrupulous procedures or provides prescriptions in exchange for money. Although these are examples of activities that can result in criminal charges for healthcare fraud, they are just a few examples.

Anyone can face allegations of fraudulent billing practices, including executives.

How can an executive face allegations of healthcare fraud?

The billing department, the physician, the pharmacist, it may seem more likely that a professional directly connected to the bill would find themselves the target of these allegations — but this is not always the case. In a recent example, the United States Department of Justice (DOJ) built charges against a New Jersey businessman who served as a president of a pharmaceutical business.

According to a recent release from the DOJ, the president was involved in a scheme that included use of a marketing company to “direct prescriptions” to his pharmacies. The agency states that the marketing company would use aggressive tactics to pressure patients to use expensive medications and worked with a telemedicine company paying kickbacks for beneficiaries who put in to fill a prescription.

The government states that claims to Medicare and TRICARE connected to the scheme led to over $30 million in fraudulent payments. When presented with the evidence, the businessman chose to accept a plea deal. He faces potential imprisonment and hundreds of thousands in fines.

How can I avoid similar allegations?

The DOJ repeatedly points to kickbacks as an issue in this case. It is important to clarify that what may appear on surface level a reasonable financial relationship could be considered an illegal kickback. Take the time to have these arrangements reviewed for potential compliance issues before moving forward.

Attorney John Rivas is responsible for this communication.

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