One lucky Florida ophthalmologist managed to snare a cool $21 million from his medicare billings last year. A hundred less fortunate doctors made due by sharing $610 million from the total doctor’s billings to medicare of $600 billion. All of this information was disclosed when medicare finally opened its books on individual doctors share of medicare billings. The strategy and tactics of robust billings allow some of our lowly medicare doctors to make even more money than those fancy doctors on television. But when does robust billing become fraud worthy of an FBI investigation?
|Is there a Doctor in my House?|
Hidden behind the rush of these recent news stories is the fact that federal investigators will begin shifting thru the cloud of statistics in order to begin targeting individual doctors in hundreds of fraud investigations.
Indicting doctors and other health care providers allegedly involved in health care fraud will become a high priority of the FBI and the United States Attorney’s Office not only in the Middle District of Florida but throughout the entire country.
Medicare fraud typically arises from either over billing or from fake billings. To prove over billing or fake billing the FBI will investigate doctors for medicare fraud under Plan B in the following ways:
First, the FBI will be look for an average mean medicare billing for each specialty. For example, it might not be unreasonable for larger billings in specialties which require more expertise.
Second, the FBI will look for an average mean in medicare billing for each part of the country segregating the billings based on the costs and history of billings in every location.
Third, the FBI will target doctors and hospitals that have billed medicare for more than the average mean of specialty and location.
Fourth, the FBI will look for disgruntled employees and former employees to gain insight as to whether there was a criminal conspiracy to over-bill medicare. Employees will be given two significant incentives of not being indicted laced with the possibility of whistle blower status with financial reward. Employees who fail to co-operate by remaining faithful to the hospital or doctor may find themselves indicted as part of a criminal conspiracy to defraud medicare.
Fifth, the FBI will gain access to business records by utilizing search warrants for criminal conduct. This can temporarily shut down the doctor’s office inducing enough immediate financial hardship to scare the doctor into co-oporating with the Government.
With the Government focused on lowering health care costs, it’s clear that it will soon declare war on doctors who may have robustly billed medicare. The ultimate objective of the Government will be the arrest, conviction and imprisonment of imminent doctors to deter others from who received payments from Medicare under Part B.
Doctors who are under investigation may not receive target letters informing them of the fact. In fact in most medicare fraud investigations a target letter is only sent after a completed investigation as a prelude to a possible negotiation with the doctor to avoid a grand jury indictment by allowing him or her to plead guilty in federal court to a significant federal crime. Any doctor who believes he or she may be a target of a federal investigation concerning medicare billing should secure immediate help from a knowledgeable federal criminal defense lawyer to avert federal indictment and prosecution.