Criminal Enforcement of Improper Health System Billing
Washington, D.C., partner Jesse Witten was interviewed for the Advisory Board Company’s Daily Briefing on the subject of criminal enforcement of improper health system billing.
The government has recently ramped up efforts to identify potential fraud in the Medicare program. This has significant consequences for hospitals and health systems, including payment denials, recoupment of overpayments, and referral to other federal agencies.
In addition to a wave of False Claims Act settlements nationwide, recently the Department of Justice (DOJ) has taken the unprecedented action of criminally prosecuting a hospital for improper billing. If convicted of fraud in a criminal case, a provider is mandatorily excluded from participation in Medicare and other federal health programs.
In the interview, Jesse highlighted key legal considerations for hospitals and health systems, such as the existing legal environment for investigating fraud, the recent criminal prosecution of a hospital and whether or not this is an emerging trend.
The material contained in this communication is informational, general in nature and does not constitute legal advice. The material contained in this communication should not be relied upon or used without consulting a lawyer to consider your specific circumstances. This communication was published on the date specified and may not include any changes in the topics, laws, rules or regulations covered. Receipt of this communication does not establish an attorney-client relationship. In some jurisdictions, this communication may be considered attorney advertising.