An internist from Long Island recently pleaded guilty to one count of conspiracy to commit health care fraud. The government claims that the physician conspired with others to order hundreds of medically unnecessary transcranial doppler scans from 2013 through 2019. The prosecution also argued that the accused used false diagnoses to further support the orders. In exchange for placing these orders, the government claims a mobile medical diagnostic company provided $100 per test in kickbacks.
Upon review of the evidence, the physician agreed to plead guilty and faces up to 10 years imprisonment and a fine of up to $250,000.
How is conspiracy to commit health care fraud different from health care fraud?
Conspiracy to commit health care fraud focuses on the agreement between two or more parties to engage in fraudulent activities, regardless of whether the individuals successfully executed the fraud. In contrast, health care fraud charges require proof that the defendant actually carried out or attempted to carry out the fraudulent scheme against a healthcare benefit program.
How does the government choose which charge to pursue?
The government may opt to pursue a charge of conspiracy to commit health care fraud instead of a direct health care fraud charge under circumstances where there is evidence of collaboration among parties to engage in fraudulent activities, but direct evidence of the fraud itself is less concrete. The government may utilize this approach when it suspects individuals or entities of planning or coordinating efforts to deceive health care programs. Charging for conspiracy allows prosecutors to address the collaborative nature of the crime, focusing on the agreement between parties to commit fraud, which can sometimes be easier to prove than the execution of the fraud itself.
The government could also use this as a bargaining tool, offering this lesser charge in exchange for cooperation. It is important that any medical professional or health care leader charged with health care fraud take the matter seriously. An attorney experienced with this niche area of law can review the details of the case and help work towards the best possible outcome.
Attorney John Rivas is responsible for this communication.
