Health Care Fraud
Punitive civil and criminal sanctions confront nearly every activity of the modern health care industry, from alleged violations of the Stark Law and the Antikickback Statute to billing fraud under the False Claims Act to compliance with HIPAA and the shifting requirements of the Affordable Care Act. As the industry consolidates it continues to receive scrutiny from a lineup of government agencies empowered to intrude into any component of health care delivery, compensation and billing, notably by the Office of Inspector General of HHS, the Department of Justice, and state Attorney General Medicaid fraud units. Moreover, the health care sector is bedeviled by the increasing number of whistleblower, or “qui tam,” lawsuits under the FCA, allowing plaintiffs to receive a healthy percentage of trebled damages, and often spurring parallel criminal investigations. Indeed, the Justice Department filed or joined a record number of False Claims Act cases in 2013. There were over 700 health care fraud convictions in federal court in 2012, and DOJ initiated investigations against nearly 2,000 targets in 2013.
Early and skillful intervention by defense counsel is essential to avoid indictment. We have provided seasoned and consistently successful representation to hospitals, health care systems, services and device suppliers, physician groups, and individual health care executives and physicians in cases alleging:
- Excessive physician compensation arrangements
- Kickback arrangements for referrals
- Improper incentives from pharmaceutical and device distributors
- Illegal hospital/physician partnership structuring
- Upcoding or miscoding of services & items
- Excessive or unnecessary services
- Insufficient documentation to support billing
- Criminal HIPAA violations
- Controlled Substance Act violations by physicians
Aside from escaping the extreme sanctions flowing from criminal charges, a robust internal investigation or defense should be designed to avoid or mitigate civil penalties and disparaging government agency press releases, and to forestall accreditation challenges and physician licensure proceedings.