When a physician, hospital, or pharmaceutical company engages in fraud against the U.S. government, it is not uncommon for the defendant to face additional penalties and sanctions beyond mere repayment of taxpayer dollars. For example, Medicare fraudsters may face incarceration and probation for engaging in this type of crime – and sentences can be quite lengthy, depending upon the severity of the fraud. Additionally, criminals involved in healthcare fraud are often required to face and defend both civil and criminal proceedings contemporaneously, requiring many to suspend their practice indefinitely and forgo treating patients in need of care.
Details of Case
In a recent case, a Detroit-area physician pleaded guilty to a staggering level of healthcare fraud, resulting in a verdict to repay $7 million taken from federal funds for Medicare. According to court documents, the 72-year old defendant was engaging in a scheme wherein she agreed to refer Medicare patients she had never met to her conspirator’s medical facility for home healthcare. In doing so, the defendant actually signed home healthcare certifications and plans of care for these patients, a certification which is required before a patient can receive in-home healthcare, despite having never actually treated the patients and never having reviewed their medical status. The defendant certified to authorities that these patients were under her care and met the eligibility requirements for home healthcare services. Under current Medicare Part A and Medicare Part B laws, a patient may qualify for reimbursement for home health services, including skilled nursing care, physical therapy, speech-language pathology services, or continued occupational services, if the patient’s treating physician certifies the need for these services. Otherwise, home healthcare is not covered by Medicare.
In addition to the physician’s submission of false documentation to the government, she has admitted to receiving kickbacks from the conspirator’s home healthcare organization for agreeing to refer as many patients as possible. Anti-kickback provisions can be found in both the False Claims Act and the Stark Law, which prohibits inappropriate financial relationships between doctors and facilities to whom they refer patients.
According to sentencing documents, the U.S. government paid $1.32 million in Medicare reimbursements to patients unlawfully referred to home healthcare services. The physician reportedly submitted close to $1.4 million in false claims to the government overall.
Possible Severe Civil Penalties
The False Claims Act contains significant civil penalties for any individual engaging in the submission of false claims, reports, or statements to the government for purposes of receiving reimbursement. Unbeknownst to many, a defendant under the False Claims Act could face civil liability amounting to three times the amount taken from taxpayers through fraud — a concept also known as treble damages.
Under the FCA, a whistleblower who comes forward with information of fraud can receive up to 30 percent of the total amount recovered by the federal government. If you are aware of healthcare fraud, which is one of the most common areas of fraud affecting federal and state governments today, we encourage you to contact Berger Montague today for more information about the whistleblower process. As is shown in today’s case, those engaging in healthcare fraud often do so with little regard to patient safety, often placing patients in unnecessary situations or subjecting patients to needless medical procedures.