I was just reading a press release from the U.S. Attorney for the Northern District of Georgia, based here in Atlanta a few blocks from my office. The prosecutors touted their recent indictment of a physician’s assistant for supposed health care fraud and other crimes. Reading this made me want to put down a few thoughts about such cases, which we have handled multiple times over the recent years.
Anyone reading our website knows that there are “federal fraud” cases, and then there are sub-species of federal fraud. Health Care Fraud is an especially dangerous and pernicious charge to defend against. For starters, the wickedly complex Federal Sentencing Guidelines make the potential sentences for Health Care Fraud even longer than what is suggested for regular run-of-the -mill fraud. Certain “specific offense characteristics” bump up the scoring mechanism when prosecutors include an allegation that an accused person’s supposedly fraudulent conduct violated one of the Health Care Fraud laws that Congress has enacted over the years.
The accused person and his or her lawyer also need to be keenly aware that there are sub-sets of Health Care Fraud. For example, there is an illegal “kickback”, which the Government defines as: “the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients)”. Anti-kickback cases are weirdly complicated with many people wondering why the Feds are interested in the normal back and forth payments that arise in many sectors of our economy.