Spotlighted once again: feds’ hard stance toward health care fraud

If there is one elevated certainty regarding the topic of fraud in the United States these days, denoted by a specific industry that is a bulls-eye target for the probes of federal and state investigators, it is this: Alleged wrongdoing in the health care realm is an apex concern of government regulators seeking to uncover and severely punish fraud-based behavior.

Many industry participants — ranging widely from doctors, hospital administrators and billing offices to medical device makers, drug manufacturers and other care-related entities — are certainly feeling the regulatory heat, which is undeniably far more scorching currently than it was in past years.

The bottom line with health care fraud is that it is at or near the top of any list focused upon behavior that allegedly undermines public trust and bilks taxpayers of money that has been paid in response to falsely submitted claims and billings.

Seemingly there is a health care-related fraud story emerging in Texas or elsewhere nationally just about every day.

Here’s one, from just last week, which prominently points to the clearly notable figure of $42 million that medical industry defendants in a federal lawsuit agreed to pay out to federal and state authorities, respectively, in a settlement.

In that matter, federal prosecutors levied these two key accusations:

  • False Medicare billings; and
  • Disguised kickbacks to doctors for referring patients

A whistleblower in the case shed light on an arrangement pursuant to which medical providers paid inflated rents to doctors for office space in buildings owned by those physicians, in return for patients being referred under the Medicare program. That scheme amounted to an unlawful kickback relationship under federal and local laws, and, as noted above, the defendant providers ended up paying dearly for their involvement in it.

It is patently clear that health care fraud is centrally on the radar scope of government regulators, with it being likely that scrutiny of medical actors will only increase in the future.