Government Targets Health Care Fraud with Rampant Investigations

According to the Department of Justice (DOJ), during its 2011 fiscal year, the agency recovered $2.4 billion in settlements and judgments in civil cases involving fraud against federal health care programs, namely Medicare and Medicaid. Its record-setting success in False Claims Act (FCA) fraud recoveries dramatically increased after President Obama's creation and implementation of the Health Care Fraud Prevention and Enforcement Action Team, which underlines his commitment to fighting health care fraud. 

"These staggering numbers clearly illustrate the DOJ's directive to collect as much money as possible and its overly aggressive approach in investigating physicians and medical professionals," explains Brian Dickerson, a white-collar crime attorney who responds to health care fraud claims and a partner at Roetzel & Andress, LPA (Washington). "The government is responding with force to nearly every whistleblower claim filed, and physicians and their practice managers, along with medical professionals and suppliers, must take swift and appropriate action when contacted by an investigator." 

Medical practice areas being targeted include home health agencies, durable medical goods suppliers, physician arrangements with pharmaceutical companies and medical testing centers, radiation oncologists, hospital agreements with physicians groups and off-center medical testing facilities.

Mr. Dickerson, who is working with several physician practices and medical suppliers involved in such investigations by the DOJ, says that having the right type of legal counsel who can strategically address whistleblower claims with the government to avoid contentious intervention is critical.

"Local business or corporate counsel, no matter how experienced and stellar, cannot adequately address the issues being raised in these investigations," he adds. "Local counsel or medical office staff simply responding to requests for documentation more often than not leads to further intervention by the government. When contacted with a claim, specialized counsel can appropriately address the government's concerns and limit the life of the investigation."

Mr. Dickerson is available to discuss the legal implications for the health care industry resulting from FCA recovery efforts as well as how medical professionals can limit their exposure to investigations.   [02/07/2012]