If you’re a health care entity, there’s a bulls-eye on your back

On Behalf of | Apr 3, 2018 | Fraud

Those is the health care industry might sometimes reasonably feel as though there is a looming presence just behind them.

That would be federal regulators who are seemingly zeroed in on suspected fraud activities like never before.

Specifically, alleged health care fraud. Task forces replete with vast investigatory powers, deep funding and zealous prosecutorial staffs have emerged in recent years to tackle what the American government now views as a top-rung nemesis. Powerful investigative teams with names like the Opioid Fraud and Abuse Detection Unit and the Medicare Fraud Strike Force work in Texas and other states across the country to identify, prosecute and convict individuals and entities charged with health care fraud spanning a broad spectrum of activities.

The overprescription of opioids is one area noted in a recent report on health care fraud scrutiny and enforcement as “a target-rich environment for investigation and prosecution.” So too is false billing by home health care providers that charge for phantom treatments and services. Bogus coding is another area that spells a laser focus for government scrutinizers. Kickbacks given to doctors and patient recruiters are similarly under a strong spotlight. The list goes on.

Health care actors — ranging from pharmaceutical manufacturers and doctors to pharmacists, nursing home principals and many other industry participants — should absolutely know that their work realm is under close and recurrent examination these days. The above-cited media report duly notes that any evidence of fraud uncovered by DOJ investigators or other law enforcers can put a suspect “in the crosshairs of a federal criminal investigation.”

That is simply a flat reality in what is a currently ramped-up enforcement area.

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