Medical and Pharmacy Providers must be aware of the Government’s expressed intention to increase healthcare fraud investigations. To combat the increasing prevalence of call centers and telemarketing in the healthcare space and the potential for fraud, the Department of Justice (DOJ) has announced that it will add a substantial number of prosecutors to investigate healthcare fraud. According to John Scanlon, assistant chief of the DOJ’s criminal division, fraud section, telemarketing has put healthcare fraud on “hyperdrive.”[1]
In the federal healthcare programs, exchanging anything of value for referrals or “leads” may be considered a crime if not properly structured by competent healthcare counsel. Improperly structured arrangements may lead to jail time, fines, crippling penalties, and exclusion from participation in the federal healthcare programs. The Anti-Kickback statute covers both ends of the arrangement, whereby those that offer or pay anything of value and those that solicit or receive anything of value are potentially culpable. The statute is broad and covers all sources of referrals and is not limited to medical providers. For example, if a telemarketer offers to provide patients in exchange for a portion of the reimbursement from a federal program, both the telemarketer and the medical provider that submitted the claim for reimbursement could be liable.
If you had, currently have, or may be contemplating an arrangement with a telemarketer or an entity with a pre-existing patient list, please reach out to competent healthcare counsel. Frier Levitt’s attorneys hold an abundance of knowledge in this space and can assist you today. Contact us to speak with an attorney.
[1] https://www.law360.com/articles/1764212/doj-to-add-more-health-care-fraud-prosecutors-official-says
