Healthcare and Medical Fraud, including Medicaid and Medicare fraud, recoveries by the US Government have seen a steady rise over the past few years. That’s to say, the amount the US Justice System has recovered from convicted defendants is up. As part of the prosecutions, the DOJ has also sought fines, restitution and forfeitures. From 2017 to 2019 the amount recovered rose from $2.1B to $2.7B. Some are predicting an even bigger uptick post-pandemic. As recently as August the Northern District of Georgia released a statement regarding a 2 million dollar settlement they reached with a defendant regarding a violation of the False Claims Act.
The False Claims Act is the main tool the US Government uses to prosecute those they charge with defrauding a federal program. Many charges brought in relation to the False Claims Act deal with healthcare fraud.
The US Government can bring charges forward relating to healthcare fraud due to many factors and violations. These can include; kickbacks, upcoding, inflated drug price, and others.
If you run a healthcare business, are a doctor or medical practitioner, or have been charged with fraud by the justice system, contact us today. Manny Arora and The Arora Law Firm have years of proven experience defending clients against fraud allegations. Many is a former prosecutor and he specializes in white collar crime. Find out more about our firm by clicking here.
Common Healthcare Fraud Charges.
Common charges surrounding Medicare/Medicaid (especially when it comes to fraudulent billing). They can include the following:
- Claiming reimbursement from Medicaid/Medicare for services not rendered.
- Unbundling; charging for separate procedures which are normally performed/charged together.
- Charging for referrals which are not needed.
- Charging for tests or services which are not needed.
- Upcoding; charging for a more expensive service when a less expensive service was actually performed (or the more expensive service was not necessary).
Why the government prosecutes these cases
The healthcare industry in The United States is extremely lucrative. Hundreds of billions of dollars change hands every year between the government, insurance companies, employers, individuals, and healthcare providers. Medicare and Medicaid are government run programs which provide certain people with the funds to undergo medical treatments. Medicare is funded entirely by the federal government and is available to those over the age of 65 and those with certain disabilities. Medicaid is both federally funded and state funded and is reserved for low-income families and individuals. Healthcare providers who treat individuals with these programs request a reimbursement from the government who then pays them through a private insurance company.
Are you under investigation in Georgia?
The DOJ is also pursuing more “whistleblower” suits, which is a civil action brought under the False Claims Act for acts that constitute fraud upon the federal government. The False Claims Act can be brought via a whistleblower complaint or after a law enforcement investigation (and it can be civil or criminal in nature). Recently, there has been an uptick in prosecutions under the False Claims Act, most deal with healthcare fraud (to include: kickbacks, upcoding, overprescribing medication, etc).
A federal investigation relating to healthcare fraud can come with serious consequences and repercussions. To avoid the worst outcomes, it is imperative to act swiftly. Your freedom, license, and reputation are all at stake, and a federal charge usually means the government has prepared well. Your best investment after being charged is to hire an attorney with experience in this field, like Manny Arora.