It's not "take an aspirin and call me in the morning" anymore
Federal Healthcare Fraud involves many entities such as medical offices, hospitals, diagnostic facilities (IDTF’s), laboratories, medical supply companies, pharmacies, home health care agencies and adult day care facilities.
These violations involve performing medical procedures that are not medically necessary for that particular patient, not performing certain procedures ― but actually billing for them as if they were performed (commonly known as phantom billing), overcharging for certain medical care, providing medical supplies to patients that do not need them, paying kickbacks to entities that refer each other business in the medical field, submitting false claims to the Medicare program and to private insurance carriers, paying patients to undergo unnecessary procedures, pretending to, but not actually offering proper medical care, ownership by non-doctors of medical facilities such as medical offices, well as many other such violations.
Here are some present-day examples:
In January 2017, a neurosurgeon in Michigan named Aria Sabit was sentenced to nearly 20 years in prison for giving patients unnecessary spinal surgeries solely to boost his own profits. He defrauded $2.8 million from healthcare programs, including Medicare and Medicaid.
Healthcare companies sometimes develop an excessive focus on boosting profits and end up breaking the law. Though all hospitals need patients in order to continue operating, it is illegal to pay for patient referrals while enrolled while enrolled with public healthcare programs. In 2016, for example, Tenet Healthcare paid over $500 million to settle allegations that it bribed prenatal clinics to refer Medicaid patients to Tenet hospitals ― even if the nearest branch was very far from where the expectant mothers lived. Tenet raked in over $145 million from Federal healthcare programs from this kickback scheme.
Compounded medicines are an important option for patients with unique treatment needs or difficulty taking standard forms of medication. Many pharmacies that offer these types of prescriptions have been known, however, to orchestrate large-scale fraud schemes. A California pharmacy was recently accused of a compounding scheme, after bribing doctors to write $3,000 prescriptions for pain creams, when the patients’ needs could have been met with $20 prescriptions. Since Medicare and Medicaid are publicly funded, it is illegal to deliberately overcharge the Government for any treatment, including pharmaceutical products.
The Sentencing Guidelines and Health Care Fraud
In Federal Medicare and Medicaid fraud cases, a defendant's prospective sentence is determined, for the most part, by the alleged dollar value of the false or fraudulent claims ― what we refer to as amount of loss. That amount of loss is used in calculating an advisory, sentencing Guideline range. The Guidelines are advisory ― Courts have to calculate them, but don't necessarily have to follow them.
For example, a defendant with no prior criminal history indicted for health care fraud will start with a base offense level of 6, which translates to 0 ― 6 months of imprisonment. If the amount of alleged loss is more than $1.5 million dollars, an additional 16 levels are added to the base, increasing the defendant's offense level to 22 and commensurate prison time to anywhere between 41 and 51 months.
Which is why it's critically important to call me. I have personally handled numerous Federal health fraud cases from initial appearance to trial and sentencing and have first-hand knowledge of how the Guidelines work.
If you or a loved one is arrested and charged with a Federal health care fraud crime, please call our 24-hour telephone number 305-461-1066 to set up an appointment and free consultation so we can assess your particular case and provide you with the best legal advice on how to proceed. If you are a medical professional, be assured that our conversation is private and is protected under attorney-client privilege.
We are solely a Criminal Defense Law Firm. That's all we do and all we have done since 1987.