A United States district judge recently sentenced a health care executive after the government accused him of running an elaborate network that benefited from the use of illegal referrals. According to the indictment, the accused owned and operated skilled nursing facilities and assisted living facilities. The government accused the businessman of using illegal bribes and kickbacks to encourage medical professionals to recommend the use of his businesses to patients.
The United States Department of Health and Human Services (HHS) continues to crackdown on allegations of healthcare fraud. The government will strike both before and after the fraudulent activity occurs. Predictive analytics allow federal investigators to flag potential violations before they occur. This tool, paired with federal investigations, allows government agencies multiple tools to gather evidence to build support allegations of fraudulent activity.
The government continues to pursue Insys related healthcare fraud investigations. Insys Therapeutics (Insys), a pharmaceutical giant, is known for manufacturing Subsys, a fentanyl-based spray used for management of severe pain suffered by cancer patients.
The United States Attorney for the Western District of New York has charged a local psychiatrist with health care fraud. The medical professional operates a private practice, has served with many nursing homes and has also spoken at consulting engagements for pharmaceutical companies.
In recent years, the government has been taking a much more aggressive approach to health care fraud enforcement, and it looks like enforcement efforts could get even more aggressive under the Trump administration.