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Fraud & Abuse Healthcare Law

We understand that Healthcare Fraud may be a lot to understand, but in simple terms, if you don’t lie, cheat or steal to make money, you should be safe right?

Well, actually, the laws can be incredibly complex. When you need to add in partnerships and sophisticated work-sharing agreements, untangling the mess of responsibility could be even more difficult.

Let us explain a few examples of healthcare law and fraud to make the problem easier to understand. But know that it’s always wise to contact a lawyer when you think you’re engaged in activity that could be considered fraudulent.

Inadvertent Healthcare Fraud Cases

It’s important that medical professionals understand healthcare laws so that they don’t accidentally make a decision that breaks a law.

Consider the Stark Law for example. Under that statute, you’re not allowed to refer a Medicare patient to any entity with which you have a financial relationship. In theory, you could break that law by:

  • Referring patients for tests and accepting a portion of the fees billed for those tests.
  • Giving your doctors an incentive for some kind of tests.
  • Improperly paying your physicians.
  • Making an arrangement with a medical center and promising to refer patients for some kind of test.

Accidental or inadvertent fraud is real, and these cases can become complex. It’s wise to work with a lawyer that specialized in healthcare law.

What About the Healthcare Fraud False Claims Act?

If you’re thinking of submitting a Medicare or Medicaid claim that pertains to fraudulent behavior, you can not do so. If you tried to submit a such claim, it’s a violation of the False Claims Act.

Healthcare Fraud Law: Criminal Studies

Sometimes, your mistakes aren’t inadvertent or paperwork related. If a medical professional is knowingly breaking a law, they will be subject to criminal charges.

Two main criminal statutes apply to medical professionals, and they involve:

  • Kickbacks. If you receive something in return for Medicaid or Medicare business, you’re involved in an illegal scheme.
  • Fraud. If you intend to falsify records or documents for your financial gain, you could face legal challenges.

Criminal charges have the possibility of a medical professional losing their license.

What Should You Do When You Suspect Fraud?

If you suspect you or someone around you is involved in something unethical, please take action.

The government recommends:

  • Stopping. Don’t submit anything else that’s fraudulent.
  • Assessing. Determine how much you’ve made on the scheme.
  • Untangling. If you’re part of a scheme to defraud, reconsider.
  • Disclosing. Own up to the mistakes you’ve made before you’re caught.

If you’re seeking guidance in any of these areas, please contact us at Florida Healthcare Law Firm.