After last month's takedown of some 400 medical professionals accused of $1.3 billion in false billings, the Justice Department intends to remain vigilant in its fight against healthcare fraud. It has just announced the creation of the nation's first Health Care Fraud Unit to focus on issues like kickback schemes, upcoding and false diagnoses.
"Health care fraud often exploits patients through unnecessary or unsafe medical procedures," said the acting U.S. Attorney for the Northern District of Illinois, where the unit will be located. "Health care providers who cheat the system must be held accountable."
The new unit will be made up of five prosecutors and two assistant U.S. attorneys. The Northern District played a role in July's giant enforcement action and also recently obtained 10 convictions in a multi-year probe into Sacred Heart Hospital in Chicago.
The Chicago area was likely also chosen because the area has a high concentration of healthcare-related companies, according to one attorney there practicing in the field. He said that the federal government will also be working with state prosecutors across the nation in order to coordinate their efforts at enforcement.
"More money and more prosecutors, the establishment of multi-agency health care task forces ... all make it clear that the feds have moved health care fraud up to one of their top priorities," he said.
The Sacred Heart Hospital case represents an example of large-scale Medicare and Medicaid fraud. According to the Courthouse News Service, executives at the hospital paid bribes and kickbacks to doctors in exchange for their referring patients for services that could be paid by Medicare and Medicaid. The scheme saw millions of Medicare and Medicaid dollars being plowed into Sacred Heart under false pretenses. The hospital closed in 2013.
Those in the healthcare field who see questionable of fraudulent behavior may wish to speak up. Particularly when the fraud involves government services, it may be possible to obtain a substantial award for blowing the whistle. That said, whistleblowers often face retaliation by their employers, even though such retaliation is prohibited by law. If you are considering blowing the whistle on fraud or other illegal behavior at your workplace, we urge you to speak with an experienced attorney before you take any action so that you can learn what to expect and how to protect your rights.