Physicians, medical groups, hospitals, and anyone who bills a government provider like Medicare must follow strict rules when making their claim for payment. Failing to abide by these rules can result in allegations of wrongdoing and lead to an investigation and potential charges for a False Claims Act (FCA)—and this law has some teeth. If the government can build a successful case, a conviction can come with steep financial penalties, potential imprisonment, and an official investigation with the possibility for additional repercussions from the state board.
Although these penalties deter wrongdoing, critics of the system argue that physicians may get off too easy and that those who abuse the system should face more serious consequences.
Critics push for prison time to hold physicians accountable for wrongdoing.
A recently released Reuters investigation dug into the issue, calling out state and federal authorities for failing to follow through and pushing for maximum penalties in many of these cases. The piece presents the critic’s stance, arguing that far too often, physicians find themselves paying a steep financial fee but not facing prison time.
Instead, critics argue that more physicians should go to prison for failing to abide by these regulations.
FCA violations are not always a sign of bad medicine.
In addition to false allegations, physicians who find themselves in the government’s crosshairs facing allegations of illegal activity may have fallen victim to confusing and unclear Medicare billing rules. What begins as allegations of egregious abuse may be an honest clerical or billing error.
Publicity could lead to a push for more convictions.
The Reuters piece could result in authorities feeling pressure to follow through and push for strict consequences when moving forward with these cases. Regardless of the impact, it serves as a reminder that physicians and other medical practitioners are wise to take allegations of an FCA violation seriously. Defense strategies are available and can be tailored to the situation, whether the claim is the result of a false allegation, a clerical mistake, or a bigger issue that requires guidance toward a resolution.
Attorney John Rivas is responsible for this communication.