Over the last few years, the Justice Department has charged over 400 people in what they consider the nation's largest healthcare fraud scheme as a result of an ongoing investigation affecting doctors, nurses, pharmacists, and other professionals in the health industry field. Over 400 people have been indicted, spearheaded by the Medicare Fraud Strike force. Charges have been lodged in more than 41 Federal district courts, charging over 100 doctors, nurses, and other licensed medical professionals. The fraud has involved over $1.3 billion, implicating individuals who perpetrated false claims and received money from Tricare or various funds or entities related to Tricare.
Some of these cases involved defendants who falsely identified themselves as former military so as to gain the respect and trust of Tricare Beneficiaries for fraudulent billing schemes. Other cases involved pharmacists who were submitting false claims to Tricare for dispensing compounded medicines that were not medically necessary. Many of the schemes involved kickbacks to sales representatives to refer Tricare prescriptions. All of these types of issues are being examined closely by the Department of Justice and other Federal agencies.
Often doctors, pharmacists, or nurses are contacted by the FBI or other law enforcement agents from other agencies and questioned regarding their possible involvement with these types of cases without even understanding the implications of their involvement or criminal culpability if they had received money directly or indirectly from these government-funded entities.
Health professionals who are concerned about their possible involvement with entities such as Tricare, or who have been contacted by law enforcement regarding their involvement would be wise to consult with an attorney before taking any action, or submitting himself or herself to questioning. Medical fraud can be complicated, and therefore it's important to have the expert legal advice from an experienced criminal defense attorney to guide you through the process.
An ounce of prevention is always worth a pound of cure, and the best way to ensure that you are making decisions in your best interest is to proceed with caution based upon wise counsel and a true understanding of all the possible implications of past actions.
Even if one's actions were taken in the belief that they were appropriate at the time, it's wisest to have professional legal advice before making the decision to speak with any investigating agencies.
Jowers, K. (2017, July 13). Tricare Cases Part of Nation's Largest-Ever Health Care Fraud Sweep. Retrieved January 5, 2018, from militarytimes.com
U. (2017, October 2). October 2, 2017: Compounding Pharmacy Owner Charged with $10 Million Health Care Fraud. Retrieved January 5, 2018, from fda.gov