Any professional can find themselves facing allegations of fraud. When the government is involved and claims you fraudulently billed a federal insurance program, like Medicare, the issue can quickly snowball into serious criminal charges. A recent example out of New York shows how these types of cases can occur within the acupuncture and therapy fields.
What are the allegations?
The case involves two acupuncturists and two physical therapists. The government claims the four medical professionals worked with an insurance company employee in a scheme to defraud the government. The prosecution states the insurance employee would refer patients to the four professionals. These four professionals would then allegedly pay the patients and the insurance employee kickbacks after the patients signed off on unnecessary services or on services never received.
To support these allegations, the government claims to have evidence that the group:
- Created false medical records to show services were rendered when they were not.
- Filed false claims for reimbursement through Medicare and other insurance providers.
- Provided cash payment to the patients in exchange for insurance information.
The United States Attorney’s Office for the Southern District of New York has charged all four with conspiracy to commit healthcare fraud and money laundering, each of which comes with up to twenty years imprisonment. Additional charges include conspiracy to violate the Anti-Kickback Statute (AKS), wire fraud, theft of government funds, and violation of the AKS.
What comes next?
The parties will begin building their cases and may attempt negotiations. Depending on the evidence, the accused may consider a deal with the government. If the government does not have evidence to fully back these claims, the accused may choose to fight back and take the matter to trial.
The example highlights how the government is aggressively pursuing claims of fraudulent billing practices. Based on their investigation, they are pushing for serious criminal charges that could come with decades imprisonment. As such, anyone that finds themselves in a similar situation is wise to take the allegations seriously.
Attorney John Rivas is responsible for this communication.