From: hounddog23x@gmail.com   
      
   Healthcare Fraud: Aggressive Enforcement Strategies    
      
      
   1/26/2015byMichael Volkov Contact    
      
   This week I am focusing on the persistent problem of healthcare fraud. For   
   healthcare providers, the challenge of compliance and avoiding enforcement   
   risks is particularly difficult.      
      
   The Justice Department and Health and Human Services had another record year   
   in their battle against healthcare fraud. DOJ recovered over $2.3 billion in   
   False Claims Act cases involving the healthcare industry.  Since 2009, DOJ has   
   exceeded $2 billion    
   in False Claims Act recoveries in the healthcare industry.    
      
   This continuing trend of aggressive civil enforcement, however, is being   
   supplemented with new criminal prosecution schemes and tactics typically   
   reserved for organized crime and narcotics trafficking organizations. Federal   
   prosecutors are using an array    
   of charging schemes and evidence gathering techniques to charge healthcare   
   fraud "enterprises" with an array of serious federal crimes.    
      
   To bring even more pressure, DOJ recently announced it is screening all false   
   claim act submissions by relators to determine if a criminal probe is   
   warranted. This is a smart move, considering that many false claims act cases   
   involve potential fraud    
   crimes.  By making criminal prosecution a priority, DOJ is sending a strong   
   message to the healthcare industry.    
      
   DOJ relies on aggressive criminal prosecutions developed by HEAT investigators   
   in high-risk jurisdictions like Miami, Detroit, New Orleans and Houston.    
   Outside these jurisdictions, DOJ relies on Medicare Fraud Strike Forces to   
   prosecute fraud cases.      
      
   The Medicare Strike Force schedules an annual nationwide takedown to highlight   
   the issue of healthcare fraud.  This year, in May 2014,  DOJ and HHS-OIG   
   announced charges against 90 individuals in six cities for Medicare fraud   
   schemes involving     
   approximately $260 million in false billings.  Twenty-seven of the 90   
   individuals charged were doctors, nurses, and other medical prof   
   ssionals.fraud    
      
   Some of the more important trends in DOJ's civil and criminal enforcement   
   strategy over the last year are outlined below:    
      
   Focus on Providers - DOJ and HHS have targeted hospitals, clinics, home   
   healthcare and skilled nursing facilities for enforcement actions. That makes   
   sense since they are the largest users of Medicare funds. Hospitals, in   
   particular, are targeted for    
   enforcement actions. Community Health Systems paid $98 million, and Amedisys   
   (home healthcare) paid $150 million, respectively, in civil settlements.    
   Following the Money - DOJ has signaled its intention to follow the proceeds of   
   healthcare fraud and prosecute those who launder proceeds. In one case, DOJ   
   prosecuted a check cashing business for its role in a wide-ranging healthcare   
   fraud scheme.    
   Using All the Tools - DOJ extended its healthcare fraud mandate and prosecuted   
   individuals for wire fraud and securities violations. Beyond these tools, DOJ   
   has used false statements, obstruction and other criminal offenses to rack up   
   charges against    
   defendants involved in healthcare fraud.    
   Charging Professionals - DOJ has prioritized prosecution of professionals for   
   healthcare fraud, including doctors, physician assistants, nurses and others   
   who may be involved in fraud schemes.    
   Quality of Care - DOJ is pushing the envelope when it comes to criminal cases   
   for quality of care issues. In most criminal cases involving this theory, DOJ   
   is able to show that the fraudsters provided worthless services.  DOJ will   
   push the criminal    
   prosecution of cases where fraudsters provide substandard care - the line   
   drawing issues in these cases will be interesting and courts will inevitably   
   be drawn into these cases to define appropriate cases for criminal   
   prosecution.    
   Judges have little tolerance for Medicare fraudsters and have imposed   
   significant sentences on criminals. They are more than happy to send these   
   fraudsters to jail for significant terms of incarceration.    
      
   fraud4For example, a Louisiana psychiatrist was sentenced to approximately   
   seven years in prison and $43.5 million in restitution, as well as forfeiture   
   of proceeds, for his role in a Medicare fraud scheme involving mental health   
   centers. Also, in    
   October 2014, a physician's assistant in a Medicare fraud scheme was sentenced   
   to 15 years in prison following his conviction after trial for health care   
   fraud.    
      
   As healthcare fraud becomes more criminalized, professionals and other   
   providers will be regular targets of enforcement actions.    
      
        
      
   Written by:    
   Michael Volkov    
      
      
      
   http://www.jdsupra.com/legalnews/healthcare-fraud-aggressive-enforcement-61133/   
      
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