Government Crackdown on Health Care Fraud Yields Record Recoveries

May 09, 2013 (Press-News.org) Government Crackdown on Health Care Fraud Yields Record Recoveries

Article provided by Nathans & Biddle, LLP
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The rising cost of health care has caused everyone to look at their spending, including the U.S. Government. Eliminating health care fraud has become a top priority. To accomplish this government agencies and law enforcement have been pouring their resources into identifying and prosecuting medical and dental professionals, suppliers, agencies, hospitals and pharmaceutical companies who have defrauded the government.

Last year, federal officials in the Obama administration utilized powers granted by the Affordable Care Act to form a partnership between health insurers and federal and state governments to crack down on health care fraud by doctors, hospitals and suppliers.

In the short time since it began, the federal government has recovered record-breaking amounts. According to Reuters, the government recaptured over $4.2 billion in funds. During that time period, they opened 1,131 cases and convicted 824 defendants.

The government crackdown is continuing its efforts to shake up the medical community. In late April, an operator of assisted living and rehabilitation facilities reached a settlement with the government. The Ensign Group, Inc. agreed to a $48 million settlement with the federal government stemming from overbilled Medicare payments. Bolstered by these large recoveries, the government's pursuit of those committing Medicaid and Medicare fraud is likely to continue.

Employee Protections Under the False Claims Act

The majority of the prosecutions are against the most common forms of health care fraud, including up-coding or billing for services that were never performed. The government is pursuing anyone who may be associated with it.

Employees who facilitate this type of fraud may be subject to criminal prosecution. To protect themselves, many employees are reporting their employers. By taking advantage of the False Claims Act, employees can obtain protection and may even be rewarded if their employers are successfully prosecuted or civilly sued by the government.

It is important for those employees to seek experienced counsel familiar with whistle blowing actions and white collar criminal defense in order to protect the employees interests in obtaining any funds from the government's qui tam actions and to protect the employee regarding any possible fraud prosecutions.

Medicare Billing Mistakes Are Easy to Make

Not everyone is trying to fleece the system. While the government's enhanced detection methods are certainly ensnaring many individuals and entities who have been taking advantage of the system, they are also pursuing many who have not and are innocent.

Medicaid and Medicare billing is complicated. Complex forms and processes make it easy for medical professionals to make unintentional billing errors. To make matters worse, new regulations are continually being added, which adds to the confusion.

There is another problem with the new wave of health care fraud prosecutions. Aggressive prosecutions may result in a shortage of health care providers who are willing to take on Medicare and Medicaid patients. Many doctors and clinics have legitimate concerns about what could happen to their practice if they make a mistake.

If suspected of health care fraud, the U.S. Department of Health and Services may suspend payments to these health care providers or disqualify them from participating in the Medicaid Assistance Program. Getting a hearing to appeal a government sanction can take months.

The consequences for making a Medicaid or Medicare billing mistake are severe. It is advisable for anyone under investigation or charged with health care fraud to speak with an experienced health care fraud defense attorney.