As we enter 2024, federal authorities have intensified their scrutiny of healthcare fraud nationwide, engaging with numerous cases against medical professionals. These cases are pivotal, with more than a dozen currently progressing through legal channels.
The scope of infractions includes:
- Unlawful financial incentives: Illegal kickbacks remain a critical area of government scrutiny.
- Unnecessary medical procedures: Authorities are cracking down on the authorization of tests lacking medical justification.
- Services not provided: The feds also review claims to see if the patients received the services.
- Inflated billing: Upcoding, or charging for more expensive services than those actually delivered, also remains a prevalent issue.
Physicians and healthcare business owners have paid out millions of dollars through settlements to resolve these matters. A notable instance involved a clinical laboratory owner who settled with the government for an excess of $10 million. This case underscores the government’s resolve to address suspect financial interactions between laboratories and referring physicians. It serves as a cautionary tale, emphasizing the necessity for medical practices to meticulously examine agreements for potential indicators of illicit activity.
Use of regular internal audits is recommended as a proactive measure to identify and address vulnerabilities before they escalate into legal allegations.
It is essential to understand that the highlighted cases represent just a fraction of healthcare billing fraud, a segment of the broader spectrum of healthcare fraud. Practices such as double billing and unbundling services to submit multiple claims are also under federal surveillance.
The ongoing legal actions in 2024 reflect continued federal scrutiny within the healthcare system, signaling that compliance and vigilance are more crucial than ever for healthcare professionals.
Attorney John Rivas is responsible for this communication.