THE #1 TARGET OF THE DOJ IS YOU – “MEDICAL CARE PROVIDERS,” AND THOSE WHO SUPPORT THE HEALTHCARE SECTOR.
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THE IMPORTANCE OF EFFECTIVE RISK MANAGEMENT
*The DOJ Fraud Section*
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PREVENTION IS SIMPLER, CHEAPER, AND MAY KEEP YOU OUT OF PRISON.
A
ADD A LITTLE CAUTION (AND PREVENTION) INTO YOUR OPERATION
CIVIL CHARGES ARE JUST MONETARY
CRIMINAL INCLUDES PRISON
[Note: Civil charges in the past were Criminal]
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D
Prevention: Legal representation that you need to have trust in.
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Here, they recover money on behalf of programs, including Medicare, Medicaid, TRICARE, the Department of Veterans Affairs (VA), and the Federal Employee Health Benefits Program (FEHBP), working closely with the United States Attorneys’ Offices, HHS-OIG, and state Medicaid Fraud Control Units.
a
Examples:
The Providers and Others in the Healthcare Sector include;
Pharmaceuticals:
Opioids: Endo Health Solutions Inc. Agrees to Global Resolution of Criminal Investigations…
Medical Devices: Innovasis Inc. and Two Top Executives Pay $12M of Improper Payments…
Durable Medical Equipment: Philips Subsidiary to Pay Over $24 Million…
Electronic Health Records; Modernizing Medicine Pay $45 M to Resolve Illegal Kickbacks…
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Managed Care (Medicare Advantage): Independent Health to Pay $98M+ in False Claims…
- The public has for years believed that Medicare Advantage Plans were Medicare. This is most evident in Snowbirds who visit Florida or Arizona in winter, only to return home upset that “those doctors” wouldn’t take their Medicare.
- Even today, it is not Medicare; instead, their options provide HMO and PPO-type versions (plus others) of Medicare. For those who are aware of this upfront, it can be an excellent alternative.
- They also have an abundance of “prior authorizations,” second opinions, or denials, as in not covered from the start. Their medication formularies will be more limited, so please check everything before signing.
Hospitals: Oklahoma City Hospital, Management Co, Physician Group Pay $72.3 M, RE, referring docs…
Laboratories: Daniel Hurt to pay$27M in connection with fraudulent cancer genomic tests.
Nursing Homes and Skilled Facilities: Agree to $45.6 M of Kickbacks to Referring Physicians.
Behavioral Health
Duke University Agrees to Pay U.S. $112.5 Million to Settle False Claims Act Allegations Related to Scientific Research Misconduct. The Whistleblower received $33,750,000 from the settlement. [My comment, as Duke is an outstanding university, and the settlement received is a lot, there may always be a lingering concern that politics was and is at the heart of this – I hope I’m wrong.]
Here, the DOJ is very clear. If you are going out of your way to avoid tariffs, this likely may result in Criminal Prosecution.
D
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THE FBI IS KNOCKING AT YOUR DOOR. WHAT DO YOU DO?
FIRST:
- LEGAL REPRESENTATION, THAT YOU TRUST AND FEEL COMFORTABLE WITH.
- QUESTIONS YOU COULD ASK WHEN CONSIDERING WHICH LAWYER IS BEST FOR YOU.
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SECOND, IF THIS BECOMES CRIMINAL:
- LEGAL REPRESENTATION,
- THEIR PRACTICE IS IN FEDERAL CRIMINAL COURT,
- WHERE THEY HAVE EXPERIENCE IN CASES LIKE YOURS.
- Two men were acquitted in Miami of $65 million scheme involving genetic and COVID-19 tests.
d
THIRD:
- CONSIDER GIVING ME A CALL REGARDING WHAT YOU ARE ABOUT TO FACE.
- HOW YOU CAN HELP YOUR LEGAL TEAM.
- QUESTIONS, THIS CALL IS ON ME.