Important Facts About the Recent Medicare Fraud Arrests

Today, the United States Department of Justice announced that it has brought criminal and civil charges against over 300 individuals as a result of a coordinated operation of the Medicare Fraud Strike Force in federal districts across the country. Those arrested today include doctors, nurses and other healthcare professionals. The government alleges that the total loss amount for all of these cases is approximately $900 million.

The Medicare fraud charges announced today involve the following different crimes:

  • Conspiracy to Commit Healthcare Fraud – This is a crime that involves an agreement between two or more people to execute a scheme to defraud or cheat any healthcare benefit program, like Medicare, Medicaid or TRICARE. Conspiracy charges like this generally involve allegations that relate to healthcare professionals submitting false claims to the government for payment of services that were not medically necessary or appropriate. Charges can also be brought under this law that focus on allegations of fraudulent conduct that involve the use of unlicensed or improperly trained individuals to provide healthcare services that are covered by Medicare and Medicaid. The types of healthcare services that are usually involved include home health care providers, psychotherapy, physical and occupational therapy, durable medical equipment suppliers (DME) and prescription drug coverage and benefits. In many of the indictments announced today, charges include healthcare fraud conspiracy allegations that relate to the Medicare Part D Prescription Drug Benefit Program.
  • Conspiracy to Violate the Anti-Kickback Statute – This crime is a general conspiracy offense that involves an agreement between two or more people to engage in conduct that would violate the Anti-Kickback Statute. The Anti-Kickback Law prohibits the payment of kickbacks and bribes in return for referring people for unnecessary medical treatment that is covered by Medicare. Common cases include allegations of bribes and improper compensation given to physicians or other healthcare providers to make referrals for treatment that would not otherwise be medically necessary or appropriate.
  • Money Laundering Offenses – Several individuals have also been charged with money laundering and conspiracy to commit money laundering. Money laundering covers two basic types of conduct – (1) engaging in certain monetary transactions knowing that the money was derived from a specified unlawful activity like healthcare fraud; and (2) using money obtained from a specified unlawful activity to promote that activity or attempt to conceal the unlawful proceeds. Many times, an individual who is charged in a healthcare fraud conspiracy will also be charged with money laundering if the government believes that profits were generated by the healthcare fraud activities.

Of course, the indictments in this case contain allegations only. There has been no evidence presented by the government to prove that these crimes actually occurred. Everyone arrested today is presumed innocent.

Our firm has defended a number of doctors and other healthcare professionals charged in healthcare fraud cases across the country. These cases generally involve a substantial number of documents and require a diligent investigation and thorough analysis to determine if the government’s case has any merit.

If there is a clear violation of the law, the punishment for crimes like this depend significantly on the amount of money that the government can prove was lost as a result of the alleged fraud. Our firm has been very successful in using forensic accounting experts and other professionals to chip away at the government’s alleged loss amount to lower the exposure for our clients and successfully resolve many of these cases.

I would not be surprised if the government is currently trying to persuade defendants in these cases to testify against their codefendants in an attempt to strengthen the government’s case. In any conspiracy case, the government will have to prove that there is an agreement to violate the law. In a complicated area like healthcare fraud, the government generally tries to rely on individuals who are allegedly involved in the fraud to testify against other people.

The individuals that do come forward and cooperate with the government may be rewarded with a significant reduction in prison time depending upon the amount of their cooperation and the specific terms of any plea agreement negotiated by their lawyers. It is critical to understand the advantages and disadvantages of cooperating with the government before entering into any such agreement or providing the government with any relevant information.

It is always best to consult a qualified federal criminal defense attorney who is experienced in complex healthcare fraud cases as soon as you have been arrested or charged with an offense like this. Our firm has successfully represented healthcare professionals for over 20 years in complex healthcare fraud cases.

We anticipate working hard to defend several individuals who were swept up in this recent Medicare Fraud Strike Force Operation. If you or someone you know has been arrested, indicted or investigated for Conspiracy to Commit Healthcare Fraud, Conspiracy to Violate the Anti-Kickback Statute, Money Laundering or other healthcare fraud related offenses, call us for a consultation about your case. We will let you know if we can help.



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