Physicians often face the challenge of managing billing and administrative tasks alongside their clinical responsibilities. To alleviate this burden, many seek assistance from third-party services or hire administrative staff. Although this may seem helpful, it is important for physicians to approach these arrangements with caution and awareness of federal regulations, such as the Anti-Kickback Statute (AKS). Although meant to reduce the risk of physicians acting for financial interest instead of their patient’s wellbeing, physicians can unintentionally violate the AKS if they enter into agreements that involve improper compensation or referrals.
In a recent example of how these cases can unfold, the United States Attorney’s Office of the Eastern District of New York is moving forward with charges against a former Long Island business owner for orchestrating a $22 million healthcare fraud, kickback, and money laundering scheme. The prosecution claims that Mr. Beretsky, the owner of a business that provided healthcare professionals with billing, consulting, and support services, was building relationships with patients as a way to receive illegal kickbacks. In their case, the prosecution argues Mr. Beretsky would only allow physicians who were willing to provide kickbacks to see these patients. They state the accused disguised the kickback as an illegal referral fee. The case is moving forward and, if convicted, the accused faces up to 20 years in prison for the money laundering conspiracy charge and 10 years for each healthcare fraud conspiracy and kickback charge.
Is this type of case common?
This is just one example of the type of case the government will pursue. Other common examples can include cases with evidence of billing for services not provided, falsifying patient diagnoses to support unnecessary procedures, or accepting kickbacks for patient referrals.
What should physicians learn from this case?
Physicians are wise to note the following lessons from the case of Oleg Beretsky:
- Stay informed: Physicians must keep abreast of the latest regulations and compliance requirements. These laws are not easy to navigate and regular training on healthcare laws can help prevent inadvertent involvement in fraudulent schemes.
- Implement compliance programs: Establishing comprehensive compliance programs within healthcare practices can help detect and prevent fraud. This includes regular audits, clear policies on billing practices, and a culture of transparency.
- Foster ethical relationships: It is important to build trust with patients and colleagues. Physicians should work towards relationships with other healthcare providers based on ethical standards, avoiding anything that could be misconstrued as kickbacks or unethical referrals.
- Watch out for suspicious behavior: Encouraging staff and patients to report any suspicious activities can help identify potential fraud early. Physicians should have clear channels for reporting and addressing concerns.
- Protect vulnerable populations: Special attention should be given to vulnerable groups, such as the elderly or immigrants, who may be more susceptible to exploitation. Providing clear information and support can empower these patients to make informed healthcare decisions.
The case of Oleg Beretsky serves as a cautionary tale for healthcare providers. By remaining vigilant and committed to ethical practices, physicians can protect their patients, their practice, and the integrity of the healthcare system. Awareness and proactive measures are key to preventing healthcare fraud and ensuring compliance with regulations.
Attorney John Rivas is responsible for this communication.
