January 31, 2013

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.

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