Attorney Comments: There are two immediate thoughts. First, the government in this case prosecuted the "actual" owner who was not on the Medicare application or the corporate paperwork. This case appears to be more of a pure fraud case. For practitioners and health care providers, the lesson to learn here is that there are companies who are controlled by others than those listed on the corporate paperwork. The government is seeking to go behind the paperwork and charge de facto owners. It is far too easy for providers to become suspects when they are not dealing with well-respected companies. The "referring physicians" were probably treated as suspects before it was discovered that they did not write the orders. What happens to the physician who writes a prescription for DME to the provider where there is then overbilling or failure to provide services? Know the providers you refer to and work with established companies if possible.
Second, for a plea agreement, the 90 month sentence in this case is long compared to sentences seen years ago. This is a trend in handing out more draconian sentences in white collar cases. With the economy, the Madoff case and the atmosphere in general towards fraud -- we can expect these increased sentences to continue. For health care fraud, the government views fraud or overbilling as damaging the fiscal integrity of the programs and making health care not available to the elderly and truly elderly. Given the lack of prosecutions and light sentences for health care fraud in the past -- it is viewed that these long sentences will act as a deterrence. Especially when they are as long as those sentences handed out for violent crime.
This trend makes it all the more important to handle investigations and legal defense early on in a thorough and professional manner. Consulting experienced legal counsel at the earliest stage possible can help assess the case and determine how best to proceed in a realistic and intelligent way.
Any questions or comments should be directed to: firstname.lastname@example.org. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers.