The United States Department of Justice (“DOJ”) brought medicare fraud charges against a prominent cardiologist after joining in on separate but ongoing whistle-blower cases.
Among the allegations, the doctor and medical group that performed the services are charged with padding bills, undergoing unnecessary procedures, offering and giving kickbacks to patients that waived their copayments, even potentially lethal operations such as catheterization of the heart.
The liability theory falls under the Federal Civil False Claims Act under 31 U.S.C. Section 3729, (“FCA”); which is one of the government’s harshest mechanisms in prosecuting waste, fraud, and abuse of public funds.
The law of the False Claims Act requires in part, that the person or entity fraudulently claims payments or approval, makes false records or statements that are material to a fraudulent claim, or conspires to get a false claim paid by the government.
These acts can be made in dozens of ways. Namely, providing medically unnecessary procedures, falsely claiming procedures that were never done, and falsifying documents.
Critics and advocates face diametrically opposed viewpoints on practitioners that coordinate large-scale operations because volume procedures that require heavy workloads can make intelligent minds disagree as to whether foul play was at hand.