Healthcare fraud law should be easy to understand. If you don’t set out to lie, cheat, or steal to make money, you should be safe, right?
Unfortunately, the laws can be incredibly complex. Add in partnerships and sophisticated work-sharing agreements, and untangling the mess of responsibility could be even more difficult.
We’ll 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
Sometimes, the decisions you make as a healthcare professional break the laws, even if you never intended to do so.
Consider the Stark Law. 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 kinds of tests.
- Improperly paying your physicians
- Making an arrangement with a medical center and promising to refer patients for some kinds of tests.
Inadvertent fraud is real, and these cases are complex. It’s wise to work with a lawyer, especially if healthcare arrangements are involved.
What About the Healthcare Fraud Law False Claims Act?
You can’t submit Medicare or Medicaid claims you know are fraudulent. Doing so is a violation of the False Claims Act, and fines are steep.
Typically, healthcare professionals know that they’re breaking this particular fraud law. They doctor the paperwork and hope to make money before anyone notices. But sloppy bookkeeping could also play a role. If you’re not absolutely sure that you’re submitting everything properly, wait and think before you take action.
Healthcare Fraud Law: Criminal Statutes
Sometimes, your mistakes aren’t inadvertent or paperwork related. If you intend to break the law and you know your conduct is wrong, you could be liable for criminal charges.
Two main criminal statutes apply to medical professionals, and they involve:
- Kickbacks. If you get something in return for Medicare or Medicaid 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 could end your career. And they could also put you in jail for long periods of time.
What Should You Do When You Suspect Fraud?
If you’ve been reading this list with a growing suspicion that you’re engaged in something unethical, 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, get out of those relationships.
- Disclosing. Own up to the mistakes you’ve made before you’re caught.
You should also work with legal counsel at this point. At Florida Healthcare Law Firm, we can help you assess the damage and find a proper path forward. Contact us for a confidential conversation.