In its continuing efforts to crack down on healthcare fraud, the Department of Justice announced on July 13, 2017, a major nationwide takedown of healthcare professionals. Four hundred and twelve individuals were charged across 41 different federal districts. Included in those arrested were 115 doctors, nurses, pharmacists, and other licensed medical professionals.
This latest mass arrest of healthcare professionals is part of the Government's continuing efforts to combat what it perceives as healthcare fraud. Usually the healthcare professional learns of an investigation or audit when visited by state or federal investigators. Many healthcare professionals, however, do not realize the potential serious consequences of meeting with government investigators and complying with requests and subpoenas for records. The investigations usually center around potential abuses such as fraudulent billing, kickbacks in the healthcare industry, improper prescribing and dispensing of controlled drugs and other violations of the complex laws which impact all healthcare professionals.
Healthcare investigations routinely include investigators contacting healthcare providers for interviews and production of medical records. The appearance of an FBI agent, State investigator or Inspector with the Office of Inspector General Department of Health & Human Services should be taken seriously.
If approached by any government investigator, healthcare professionals should not speak with the agents without counsel. Often, an investigator will seek to obtain medical records. It is important that the healthcare professional produce such records only with the assistance of experienced counsel so as to avoid later claims of fabricating, altering or destroying documents which can result in increased chances of prosecution.
Regulations concerning the healthcare industry including billing, coding, medical necessity of procedures, and payments classified as kickbacks are complicated and can result in the arrest of a healthcare professional. The best course of action for any healthcare professional is to diligently attempt to comply with the complex rules and regulations and if confronted by an investigation or audit, to retain an experienced counsel.
The Department of Justice’s public announcement of July 13, 2017 sets forth that 412 people were arrested. What the DOJ announcement does not disclose is the number of healthcare professionals who were not arrested because an experienced criminal defense attorney convinced the government that the client should not be charged. In addition, what we do not know is how many of the healthcare professionals arrested will be found not guilty because of retaining an experienced white-collar defense attorney. It must be remembered that not only is the defendant presumed innocent, but also, the government investigators can and do make mistakes when enforcing the complicated laws governing the healthcare industry.