Investigating health care fraud schemes takes a team approach

You may believe that no one in your office would engage in health care fraud. 

However, if you have a busy medical practice or pharmacy, it is not always possible for you to keep an eye on the activities of your staff. 

A little background 

One reason health care fraud is so common in our country is that it is an almost invisible effort that can continue successfully for years. One person alone can perpetuate the fraud, but often a network of people surfaces. 

For example, in September 2019, federal officials announced charges pertaining to a Medicare scam that involved 35 individuals who together submitted over $2.1 billion in false Medicare claims. In this scam, Medicare received bills for unnecessary cancer screenings or genetic testing. The unlawful distribution of prescription opioids is another common example of health care fraud. 

A case in point 

Another September 2019 announcement from the Justice Department enlightened the public about Texas health care fraud involving the billing of Medicare, Medicaid, private insurance companies and others for prescription drugs that patients did not purchase or receive. The authorities charged dozens of people in a trafficking network with diverting more than 23 million opioids. In all, 58 people received charges for their part in the health care scam. Of these, there were 16 medical professionals including several doctors. 

The health care fraud investigation was a coordinated team effort among several state and federal agencies including the FBI, the Health and Human Services division of the Office of Inspector General and the Drug Enforcement Administration plus the Texas State Medicaid Fraud Control Units. 

Investigation awareness 

If health care fraud is occurring at your place of work, you must consider your next steps, and the sooner the better. The time to begin developing a strategy for your defense is the moment you become aware that you or your company or practice are the subjects of an investigation for possible administrative or legal irregularities. Your rights, your livelihood and your future are at stake, and you will want the best outcome possible for your case.