Healthcare Fraud Recent Trends
Fraudulent billing schemes are a top priority for the Department of Justice (“DOJ”). The DOJ has increased its prosecution efforts to police fraudulent billing practices either by initiating its own investigations or working with private parties via qui tam lawsuits.
Recent months have demonstrated an increasing trend and intent by the DOJ to prosecute instances of fraudulent billing schemes and Medicare frauds. Such frauds are especially prevalent and noticeable as medical professionals and companies deal with COVID-19. For instance, unnecessary COVID-19 testing or unreasonable medical treatment and procedures continue to be billed to the government.
Whether improper billing charges result from a healthcare provider’s mistaken use of codes or an intent to defraud the government, the DOJ aggressively prosecutes all instances of fraudulent billing. The DOJ deeply scrutinizes individuals and companies for improper billing and will not hesitate to bring criminal and civil charges. The DOJ does not sympathize with making innocent mistakes or honest mistakes when submitting bills to the government for payment. Under federal legislation, the government does not need to prove intent to bring civil charges.
This is why it is so important for healthcare providers and healthcare companies to be vigilant of recent DOJ trends regarding healthcare frauds, especially fraudulent billing scams.
What Is Improper Billing?
Improper billing can occur in a variety of ways. The most common instances include billing for medical services that were not provided or billing for medical products and goods that were not delivered. Other common examples include the mistaken or fraudulent use of medical codes, duplicate billings to the government for the same service, split or separate billings over a few days for services that only occurred on one day, and submitting other false statements or certifications. Improper billing also occurs from billing the government for services provided that were either not reasonable or not necessary under the circumstances.
Charges of fraudulent billing can lead to civil and criminal liability under the False Claims Act. The False Claims Act prohibits the submission of false documents or false bills to a governmental agency. Any healthcare provider or healthcare company that is found to have submitted a false statement to the government can be prosecuted under the False Claims Act and liable for treble damages three times the amount of damages incurred by the government, plus additional civil fines. Each fraudulent billing is regarded as a separate offense, which can make penalties add up quickly.
Recent DOJ Prosecutions Involving Improper Billing
The DOJ has been increasingly active in initiating prosecutions for suspected billing fraud. Below are some recent Department of Justice cases involving healthcare fraud against the U.S. government, focusing mainly on improper billing allegations:
- August 25, 2020: In Houston, a pain management physician paid $530,000 to settle allegations that he falsely billed Medicare for electro-acupuncture devices. Dr. Syed Nasir was alleged to have billed Medicare for the implantation of neurostimulator electrodes, a surgical procedure that typically requires the use of an operating room. Medicare pays thousands of dollars for this procedure; however, Nasir did not perform these surgeries but instead simply applied a device for electro-acupuncture, which is just inserted in patients’ ears.
- August 7, 2020: Connecticut dentist entered into a civil settlement with federal and state governments to pay $148,000 to resolve allegations of causing overpayments to the Connecticut Medicaid Program. After the dentist’s conscious sedation permit expired, he did not renew it but continued to provide anaesthesia and sedation services to Medicaid patients undergoing oral surgical procedures. The dentist then improperly billed Medicaid for these services that he performed without a permit.
- July 13, 2020: Longwood Management Corporation and 27 affiliated skilled nursing facilities agreed to settle allegations of violating the False Claims Act by submitting false statements and claims to Medicare for rehabilitation therapy services that were not reasonable or were not necessary. The DOJ made clear that when healthcare professionals seek to maximize revenue rather than focus on the best interests of their patients, they will be held accountable.
- June 30, 2020: An anaesthesiologist agreed to pay $100,000 to resolve allegations of falsely billing Medicare for the use of acupuncture equipment. Dr. Jaime Robledo billed Medicare for implanting neurostimulator electrodes a surgical procedure but he did not actually perform these surgeries. Instead, he applied a device used for electro-acupuncture. Medicare does not provide reimbursement for such services.
- June 5, 2020: Alaska Neurology Center LLC and its owner agreed to pay $2 million to resolve False Claims Act allegations that the company knowingly submitted false billing claims to federal healthcare programs. From March 2013 to June 2018, Alaska Neurology Center LLC perpetrated multiple fraudulent billing schemes including submitting claims with false dates of service, resubmitting claims with false services or false diagnosis information, and submitting claims using multiple billing codes. These allegations came from a whistleblower lawsuit the qui tam provision of the False Claims Act.
- May 5, 2020: Connecticut Counseling Centers (“CCC”) entered into a civil settlement with both federal and state governments to pay $295,000 to resolve allegations that it caused overpayments to the Connecticut Medicaid Program from the improper billing for urine drug testing services. CCC had been non-compliant in audits with the weekly rate payment regulation and caused Medicaid to pay for certain claims twice. The U.S. Attorney on this case noted that providers who bill government health insurance programs must follow the rules or will face serious consequences.
- April 6, 2020: A New Jersey Chiropractor agreed to pay the United States $2 million to resolve False Claims Act allegations that he knowingly billed Medicare for medically-unnecessary viscosupplementation injections and knee braces and that he received illegal kickbacks. The government alleged that the chiropractor billed Medicare for viscosupplementation injections for patients who did not need them and provided unnecessary custom knee braces to patients, among other charges.
- March 11, 2020: Millennium Physicians Association PLLC paid the United States over $1.2 million to resolve claims that they improperly billed the Medicare program for sleep studies. This claim began following a whistleblower lawsuit, which eventually revealed that the company improperly billed and received payments for sleep tests without having the required credentialed technicians present and that two of the company’s sleep test facilities did not have the required accreditation or certification.
What to Look for When Hiring A Healthcare Fraud Defense Attorney
When it comes to hiring a team of defense attorneys to handle your case involving improper billing, Medicare fraud, False Claims Act allegations, or other types of healthcare fraud, it is critical that you ensure that your attorney checks the following boxes:
- Experience: Your attorney and law firm should have extensive experience in federal litigation, including both at the investigative and litigation stages. An experienced attorney in healthcare defense will understand the complex and constantly evolving federal rules of procedure and federal legislation pertaining to your defense. At The Criminal Defense Firm, our healthcare defense attorneys include former federal special agents and attorneys with decades of experience in healthcare fraud, including improper billing charges, Medicare fraud, and federal program fraud defense.
- Track Record: A law firm with a steady, consistent, and strong track record for success is a great indicator of the firm’s experience, knowledge, and education in action. The Criminal Defense Firm has an impressive success record when it comes to defending clients in federal court against improper billing charges and other types of healthcare fraud. Its team of healthcare fraud defense attorneys regularly obtains settlements in their clients’ favor as well as verdicts that result in no civil or criminal liability.
- Dedication: A pivotal feature to look for in a law firm and team of attorneys is their dedication to their clients. An attorney that is dedicated not only to the financial success of their clients’ case but also to the wellbeing and security of their clients makes a significant difference. The attorneys at The Criminal Defense Firm have the dedication, commitment, and passion to fight for their clients’ rights regardless of the case’s complexity.
- Communication: It is important for clients to have an attorney that maintains open, direct, and frequent communications with their clients at all times. This helps clients feel confident that their case is being effectively managed in their favor. At The Criminal Defense Firm, our team of healthcare defense attorneys make it their top priority to keep their clients informed and involved in the decision-making of their case. The attorneys at The Criminal Defense Firm are available to speak with new and existing clients during the evening hours, at night, and on weekends.
Because we have attorneys living and licensed across the nation, you can be confident that there is an experienced, dedicated, and successful attorney near you who is ready to speak with you and defend your case.
If you have any questions or need help regarding improper billing charges or other allegations of healthcare fraud or False Claims Act violations, contact The Criminal Defense Firm team of healthcare fraud defense attorneys today for a free and confidential consultation.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.