Fraud is a concept that has been in the criminal justice system forever. Google defines it as an intentional deception used to gain an unfair advantage or benefit, often involving financial gains. How does the Department of Justice prosecute fraud? Below is a non exhaustive list of charges that the DOJ can bring.
Billing to the United States government presents a unique set of legal requirements for healthcare professionals. Physicians who participate in federal healthcare programs like Medicare and Medicaid are subject to strict billing regulations. Even inadvertent errors can lead to severe legal consequences, including criminal charges. Understanding these laws and the potential risk of noncompliance is crucial for healthcare providers.
When the federal government is paying for items or services rendered to Medicare or Medicaid beneficiaries, federal fraud and abuse laws apply. Healthcare professionals influence what services patients receive and are responsible for the documentation of those services. That documentation is the basis for bills sent to insurers, and ultimately, the Government’s payment of a beneficiary’s medical claims.
If a physician knew or should have known that the submitted claim was false, the attempt to collect unearned money constitutes a violation. Federal fraud and abuse laws include the following:
The federal government may target organizations and businesses as well as individuals for violations of federal criminal statutes. For example, in the health care realm, cases can include office managers, practitioners from doctors, nurses to pharmacists to all other aspects of the medical industry. Recent federal investigations have targeted pill mills, medicaid fraud, and accepting kickbacks among others.
Experienced federal criminal defense attorneys like those at Conaway & Strickler, PC may suggest early on about the possibility of entering into a “deferred prosecution agreement” which is essentially a contract with the Department of Justice. DPAs are frequently used in cases involving corporate fraud, bribery, and antitrust violations. These pretrial agreements may involve an admission of wrongdoing, the payment of fines, and the implementation of compliance measures. Charges may be dropped if the defendant complies with the requirements of the agreement. Generally, the Assistant United States Attorney will file the criminal complaint and the DPA with the court, so it is of public record. This will be accompanied by a formal request to the court that any prosecution be delayed according to the terms of the DPA, allowing the defendant to fulfill its agreed-upon actions. This is very similar to conditional discharge / pre trial diversion agreements found at the state level.
An example of a DPA would be one that was entered in to by the DOJ and Teva Pharmaceuticals USA, Inc in August 2023 in response to the company’s involvement in a price fixing conspiracy involving several pharmaceuticals. As seen in this example, terms can include paying a fine, waiving certain rights, agreeing to a factual basis for the charges, and an agreement to cooperate and compliance monitoring and of course, agreeing to what will happen if there is a breach of the agreement.
Physicians who are arrested face a multitude of other issues. They will face possible termination from their job. But, also they will face issues with the Georgia Composite Board. It is very important to understand that those who are arrested may hire a firm like us and enter into an informal resolution to avoid formal proceedings, additional costs, and potentially more severe sanctions with the Composite Board. It is important to be aware of other possible consequences of such stipulations, including the following:
As a nurse, your license is one of your most valuable assets. Yet, complaints or accusations against you could jeopardize your ability to practice. At Conaway & Strickler, P.C., we understand the gravity of these situations and are here to help. Attorney Meg Strickler is experienced license defense attorney who has handled these issues for years. Below are some questions and answers that will help you navigate any issues you might having with the Nursing Board.
Question: What types of issues come before the State of Georgia Nursing Board?
Answer: Below are some common issues the Board handles. Many of these issues may overlap, as most of this conduct also constitutes a crime.
The DOJ just announced more successes in health care prosecutions involving approximately $2.75 billion in intended losses and $1.6 billion in actual losses. The case descriptions are varied, but the main jist is the same: the DOJ is utilizing nationwide efforts to crack down on health care fraud. Attorney General Merrick Garland stated that law enforcement has been working hard across 32 federal districts, and has filed charges against 193 defendants, for their roles in health care fraud schemes.
But, also he made sure to point out that in addition to the charges and arrests being announced, that the government also seized over $230 million in cash, luxury vehicles, gold, and other assets in connection with these cases.
The government comes after you with search warrants, warrants to freeze and seize your assets and subpoenas for your records. Do not attempt to deal with these things alone Contact us so we can protect your license, your livelihood and your assets.
What is Medicaid? Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources.
What is Georgia Medicaid? Medicaid is a “medical assistance program that helps many people who cannot afford medical care pay for some or all of their medical bills. Medicaid is administered by the Georgia Department of Community Health and pays medical bills with state and federal tax money.”
What is Medicaid Fraud?
On June 13, 2024, two health care executives of Done Global Inc were indicted for health care fraud related charges. The indictment alleges that the two participated in a scheme to distribute Adderall over the internet, conspire to commit health care fraud in connection with the submission of false and fraudulent claims for reimbursement for Adderall and other stimulants, and obstruct justice.
“As alleged, these defendants exploited the COVID-19 pandemic to develop and carry out a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose,” said Attorney General Merrick B. Garland. These arrests mark the DOJ’s 1st criminal drug distribution prosecutions related to prescribing via telemedicine, the agency said.
Conaway & Strickler represent healthcare providers in fighting against allegations such as these by agencies such as the DOJ, HHS-OIG, FBI, Georgia Medicaid Fraud Control Units and cases nationwide. We have litigated federal healthcare cases in NJ, NY, LA, FL, TX and GA. We also represent healthcare providers in medical and professional licensing board matters as well.
By: Onisuru Ojegba, Legal Intern to Firm
J.D. Candidate, Class of 2025
The George Washington University Law School
Attorney General Merrick Garland made recent comments about what he considered to be the Department of Justice’s top priorities for 2022. Since taking office in March 2021, Garland has tried to combat crime in a tumultuous time. He has been criticized for his handling of January 6 investigation and has stated it’s the most urgent probe in history.
With all of this going on, the US Attorney’s office increased its prosecutions of individuals of white collar crimes in the year 2021. White collar charges like fraud, theft, corruption, bribery, environmental crime, tax fraud, health care fraud, procurement fraud, money laundering, PPP loan fraud, etc will continue to get more attention from the Department of Justice.
What does this mean? It means that investigations of any sort need to be taken seriously and that you should contact a lawyer immediately if any wrongdoing is alleged.
Georgia Criminal Defense Lawyers Blog