On June 22, 2016, Federal officials from the Justice Department, along with the FBI, HHS, and the Medicare Fraud Strike Force, announced civil and criminal charges against 301 individuals and medical professionals who allegedly charged Medicare and other government programs over $900 million in allegedly fraudulent billing. Many of the charges involve relationships and arrangements among various providers, marketers and marketing companies. The claims include conspiracy to commit health care fraud, violations of State and Federal Anti-Kickback Statutes, money laundering and aggravated identity theft.
The cases are being advanced against a variety of different healthcare entities and providers, including physicians, pharmacies, medical clinics, home healthcare agencies, psychotherapy, physical and occupational therapist, and durable medical equipment providers. Both retail and compounding pharmacies were also targeted by the DOJ, which are being prosecuted for billing government programs (including Medicare, Medicaid, and TRICARE) for treatments or prescriptions that were allegedly medically unnecessary and, in some instances, allegedly never provided. The DOJ has even begun targeting pharmacies over their relationships with marketing representatives and patient recruiters, having issued indictments to certain marketers and recruiters as well. In addition to the criminal charges, the DOJ has also instituted claims for criminal forfeiture of the proceeds stemming from these alleged criminal acts.
Clearly, in today’s regulatory environment, healthcare providers must vigilantly ensure compliance with State and Federal laws and regulations. That being said, legal defenses are potentially available to many claims. The Anti-Kickback Statute contains various Safe Harbors designed to protect healthcare entities when engaging in legitimate business arrangements. In addition, even activities falling outside the strict contours of the Safe Harbors may be defensible.
Pharmacies, medical clinics, physicians, and marketers should be aware of their legal rights and implications of receiving a Civil Investigative Demand, a grand jury subpoena, an indictment or complaint related to these types of violations. Frier Levitt’s twenty-five healthcare attorneys include pharmacists, nurses and former government prosecutors. In addition to handling white collar healthcare criminal matters, we often serve as special counsel to other criminal attorneys throughout the country as to the unique aspects of the Anti-Kickback Statute, other healthcare statutes and technical/clinical compounding issues. Contact Frier Levitt today to learn how we can help.
