Healthcare fraud has been raised as a matter of concern not only in Chicago but in the country as a whole. It raises the costs of providing healthcare and also means that vulnerable people who need support are left behind. The cases in this category are unique because they often provide a corporate entity that is tasked with the role of distributing healthcare services. The large scale Medicare fraud occurs within the modalities of overcharging the state or alternatively charging it for services that were never delivered. In either case, the consequences for those involved can be dire. They could lose the license to practice and may be banned from government contracts for a considerable period of time.
Over time, a number of fairly consistent patterns of offending have emerged. First of all, there are three main modalities including Medicare Fraud, Medicaid Fraud, and Kickbacks. Each of these modalities are united by deceit and illegal benefits. For example, overbilling has been a persistent problem in Medicaid and Medicare programs, despite the stringent protective measures that were adopted by Congress and local legislatures. In some cases, the service provider is so overwhelmed by paperwork and bureaucracy that they end up making inadvertent mistakes. Obviously the courts will take into consideration both the act and the intention behind it before passing judgement.
Damaging the Integrity of the System
The most common legislative instrument for pursuing these crimes is 18 U.S.C. 1347. The instrument is credited with increasing the number of prosecutions over the years. Kickbacks are a form of insidious corruption that is treated as a serious infringement by the authorities. They are particularly damaging because they create a conflict of interest between the public service and the provider’s self-interest. Another new form of fraud that is gaining traction in the industry is that of pill mills. This is where physicians prescribe medication for resale rather than for use. Alternatively, the physicians prescribe medications that are neither necessary nor useful to the patient, but still earn the physician money from the state. The victims could include a health insurance company that picks up the tabs for the fraudulent expenses.
The Anti-Kickback Statute was designed to deal with some of these problems, but the culprits continue to get away with them by circumventing the controls that are put in place. For example, they can submit valid claims, but in duplicate or triplicate so that they get more money than they are entitled to. At the firm level, it is possible to cheat the state by asking a non-physician colleague to provide health-related services and then charging for them as if you were the one that provided those services. For obvious reasons, there is a leverage between the costs of professional and nonprofessional service provision.
Individual service users might be part of the scam and could be incorporated into the healthcare fraud case. For example, they may ask for the co-pay to be waived so that they get full benefits to which they are not entitled. The FBI as well as the Health and Human Services (HHS) are invariably involved because of the federal nature of the crime and the fact that the federal government spends a lot of funds on these healthcare programs (see the Alexsander Gordin case). The Southern District of Illinois remains the top area for Health Care Fraud Prosecutions. Nevertheless, those prosecutions are just a fraction of the $80 billion that is lost by the government through this type of crime.
Any defendant that is facing these types of charges can expect a very complex and determined prosecution. Therefore, their defense team must be similarly robust. Call David Freidberg Attorney at Law now at 312-560-7100 to get the legal help you deserve.
(image courtesy of Daniel Frank)