It’s Just the Latest Case in a String of Dallas Health Care Fraud Investigations
Dallas doctors are no strangers to health care fraud fines, audits, or even criminal prosecutions. We’re a big city, with a lot of providers and even more patients.
In Dallas County alone, there are more than a quarter-million Medicare beneficiaries (286,077 as of 2014, compared to a total residential population of appx. 2.5 million, putting Dallas at a beneficiary density of 117 per 1,000 residents – one of the highest in the country). That number rises even higher when you add in beneficiaries of Medicaid and other programs.
The very high Medicare / Medicaid population here is the reason Dallas is one of just nine American cities that are now home to a United States Strike Force office specifically designated for policing Medicare fraud.
The Dallas Strike Force is an incredibly active office. It is well staffed, well-funded, thoroughly trained, and supported by the enormous cooperative resources of the federal government.
Health care fraud investigators work directly with state and local law enforcement, as well as CMS and its private contractors. Together they pursue both criminal charges and civil enforcement proceedings that can net the government millions of dollars in back payment and restitution from health care providers.
Today, we’re detailing one of the more recent high-profile health care fraud takedowns in Dallas.
Inside the Case: How Marketing Kickbacks Put a Dallas Hospital in Hot Water
Pine Creek Medical Center, LLC is a physician-owned hospital based in Dallas and serving patients throughout the Dallas / Fort Worth area. Earlier this month, on December 1, 2017, the hospital agreed to pay the federal government $7.5 million to resolve allegations by the U.S. Department of Justice that Pine Creek violated the False Claims Act.
Specifically, the government accused Pine Creek of giving doctors kickbacks for referring surgeries to their hospital. In this case, the kickbacks weren’t direct monetary payments. Rather, Pine Creek allegedly paid for marketing and advertising on the doctors’ behalf — still a kickback in the government’s eyes.
For the most part, those payments were for services many people might think of as relatively harmless:
- Advertisements in local and regional publications
- Upgrades to the doctors’ website design
- Creating business card and brochures
- Radio and TV ads
- Pay-per-click ad campaigns
- Local billboard displays
The case is a useful reminder for physicians that the government uses a much broader definition of “kickback” than the general public does in everyday conversation.
The patients referred to Pine Creek in exchange for kickbacks included several Medicare and TRICARE beneficiaries, bringing the practice within the purview of the False Claims Act.
The case originated in a qui tam action filed by two of Pine Creek’s former marketing employees. When all was said and done, the whistleblowing employees got to keep $1,125,000 for their time and effort. In that sense, the case is also a reminder for medical clinics that there are huge rewards available to your employees if they can build a case against you.
In addition to the multi-million-dollar payout, Pine Creek agreed to undertake a wide range of corporate compliance reforms over the next five years. That agreement is being overseen by the Department of Health and Human Services Office of Inspector General (DHHS-OIG).
What Is the False Claims Act?
The False Claims Act is the single most powerful and effective statutory tool the federal government has in its fight against Medicare fraud, waste, and abuse.
The Act has many provisions. It allows the government to impose fines for errant billing. It contains anti-kickback provisions like those invoked in the Pine Creek case. (Indeed, the False Claims Act is just one of several statutes used against alleged kickback schemes in the United States).
Perhaps most notably, it is also the law that allows disgruntled patients, ex-employees, and other individual community members to initiate qui tam actions against medical providers on the government’s behalf (and keep a portion of the recovery for themselves).
So many of the health care fraud cases in Dallas begin as qui tam lawsuits. In that sense, the Pine Creek case is typical of the health care fraud investigations that are so pervasive in the Dallas / Fort Worth area and across Texas.
Huge Health Care Fraud Fines Aren’t the Only Concern: There’s Prison Too
The Department of Justice pursued the Pine Creek case as a civil enforcement proceeding. That isn’t uncommon. In many of these cases, the government’s principal goal is to recover money. But in some cases, the individuals and/or corporations involved in these cases can face criminal prosecution too.
Laws commonly used against doctors, pharmacists, nurses, hospitals, business executives, and other medical professionals include:
- Conspiracy / Attempt: 18 U.S. Code § 1349
- Health Care Fraud: 18 U.S. Code § 1347
- Wire Fraud: 18 U.S. Code § 1343
- Mail Fraud: 18 U.S. Code § 1341
Talk to Our Dallas Health Care Fraud Defense Lawyers Today
If you are a health care provider in the Dallas / Fort Worth area, you should familiarize yourself with the ongoing Strike Force activity in our community. This is especially true if you treat even a moderate number of patients covered by Medicaid, Medicare, or other federal benefit programs.
The Strike Force office was established in Dallas specifically to probe providers in this area, owing to the high rate of CMS invoicing activity that happens here.
As experienced Dallas health care fraud defense lawyers, we can help in several key ways, including:
- Advising you proactively so that you avoid problems with the Strike Force, DOJ, or other federal agencies
- Helping you in the early stages of an audit or investigation to end them quickly and without complication
- Negotiating with federal law enforcement agents, CMS contractors, and others on your behalf
- Strategically defending you against qui tam lawsuits
- Passionate and aggressive criminal defense against any health care fraud prosecution
If you are located outside Texas, we can still help. Oberheiden, P.C. is a national reach, federal law health care fraud, defense firm. We are a team of former federal prosecutors who handle cases of all sizes, including complex and high-profile cases, all across the country.
We offer free, confidential consultations. To talk with a Dallas health care fraud defense lawyer today, please contact us online or call (888) 727-0472.
National Defense Law Firm. Primary Office in Dallas, TX.