Healthcare Fraud = Vigourous Prosecution


The Department of Justice (DOJ) is making the prosecution of healthcare fraud a priority. This is straight from the mouth of DOJ's chief of the Health Care Fraud Unit, whose name is Hank Walther.

In a recent interview, Walter revealed that DOJ is committing significant resources to fighting healthcare fraud. Since the creation of the Medicare Fraud Strike Force in 2007, the number of prosecutors working on such fraud cases has increased from six to over twenty. In 2009 alone, the DOJ: (i) won or negotiated approximately $1.63 billion in judgments and settlements, (ii) opened more than 1000 new criminal healthcare fraud investigations, and (iii) convicted 580 defendants. The DOJ is focusing on services that tend to have high concentrations of fraud: infusion therapy, durable medical equipment, home healthcare, and physical therapy.

But for providers who worry that simple errors or mistakes will cause them to be the target of prosecution, Walther offers some reassurances. He points out there has always been clear criminal intent in the cases that the DOJ has pursued. He suggests an organization use the self-disclosure protocols if it discovers that criminal fraud may have occurred. Also, it is often abnormalities in the billing data that send the initial red flag to the DOJ.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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