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What Is Hospice Care Fraud?


Would you need a health care fraud attorney if you were suspected of hospice fraud? Unfortunately, there have been more prosecutions of late for hospice fraud and it’s something which occurs all too frequently. The truth is that in recent years, a few high-profile cases have caused insurers to look closely at the amount of expenses requested for patients. It’s not that the insurers don’t want to pay the coverage, but rather, they want to ensure they aren’t getting defrauded. So, do you know what hospice care fraud is and what to do should you ever be accused of such a crime?

What Is Hospice Care Fraud?

Fraud comes in all forms. Hospice care fraud is when a patient receives cover for treatment that is never given or isn’t entitled to. A hospice can be accused of fraud when they benefit from the insurance claim – financially – and if insurers believe that’s the case, they will look to prosecute the offending health care facility. Essentially, if an insurer believes a hospice has given unnecessary services or treatment to patients, they may pursue a fraud case. A health care lawyer would be required to help defend the hospice against the action as, if found guilty, the person responsible for the fraud could face imprisonment and a fine of over ten thousand dollars. Check here!

Why Contact A Health Care Fraud Attorney?

Fraud is a serious charge. You can believe you’re innocent, but belief doesn’t win a case. Answering to a fraud charge can be life-changing, and for medical practitioners, they may even lose their license to practice in that state also. That’s why you really need to contact a health care lawyer and get the trouble sorted. It doesn’t matter if you think you’ll win your case at court or otherwise, you must have someone defending you. They are the best people to defend you against such action and they may make all the difference when it comes to winning your case at court.

Is A Lawyer Necessary?

You aren’t always convinced you need a criminal attorney or lawyer when facing a serious charge as fraud; however, this is not something you can defend yourself against. You do not have any legal experience and that means you’re at a disadvantage. It’s essential to get someone on your side and who can help defend you against these charges. A health care fraud attorney is the person to prevent you being convicted of these charges. While you might think it’ll all go away, it won’t! Fraud is a serious business and you need an attorney to help you.

Protect Yourself against Fraud Charges

Fraud is a common issue in the health care world and it’s not something that’s going away anytime soon. Unfortunately, insurers are coming down hard on all health care providers if they think any wrongdoing has taken place. Yes, you mightn’t see your actions as fraud, but that doesn’t mean the insurers or the police won’t. That’s why you have to be extra careful when it comes to defending yourself against a fraud action. A health care lawyer can be a useful professional to have fighting your corner. For more details, visit:  https://en.wikipedia.org/wiki/Medicare_Fraud_Strike_Force

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What Is The Difference Between Healthcare Fraud And Healthcare Abuse?

A healthcare lawyer may be required if there is suspected healthcare abuse or fraud. While you might think fraud and abuse of the healthcare system isn’t possible, you’re very much mistaken. Fraud is one of the worst problems within the medical profession today, and it’s not just patients who are responsible, sometimes, doctors and healthcare professionals are at fault. However, do you know the difference between healthcare fraud and abuse? If not, it’s time you understood what they mean and how they could impact your career. Click here!

Fraud and Abuse – What’s The Difference?

Healthcare abuse is essentially charging more for services rendered or add unnecessary costs onto those services. Healthcare fraud is knowingly and intentionally billing for services which were never given. In the end, it comes down to the intent of the action of the person committing the offense. For example, a patient may say they’ve received additional treatment from a physiotherapist, or say they will in the future, and claim for a cost higher than what the actual treatment will be, pocketing the additional money left over. That’s fraud. Another example is when a doctor knowingly puts in a claim for treatment that was never given and them receiving the total cost personally. A healthcare fraud attorney might be required if you’re suspected of this crime.

Abuse and Fraud Are Closely Link

There’s the old argument that abuse of the healthcare system is not a crime, but that’s not quite the case. Abuse of the healthcare system is a crime, and while it might not appear as bad as healthcare fraud, it’s pretty bad. Fraud of the healthcare system is an abuse of the healthcare system also, but also, if committed by a doctor, an abuse of the patient. The truth is that fraud and abuse are closely linked with one another and if you are suspected of these crimes, consult a healthcare lawyer. For more information visit:

Prevention Is Crucial

Fraud and abuse of the healthcare system is often tough to spot, whether you’re a patient or a doctor. Sometimes, patients don’t suspect of their doctors of fraud, and it’s easy to see why. You don’t expect a medical doctor to commit an act of fraud; however, that doesn’t mean to say it can’t happen. It’s the same with patients; they too can commit fraud or an abuse of the healthcare system. Preventing fraud is a necessity. Is the procedure necessary? Has the patient been verified as eligible for the treatment? Always double check the patient and their medical history. You should always think about whether the diagnosis is correct so that you can help prevent fraud. If you’ve been suspected of fraud, contact a healthcare fraud attorney.

Get Help When You Need It

Healthcare fraud and abuse are serious problems and they can be committed by anyone, including a member of the medical profession. Whenever you’re suspected of fraud, you must seek help from a trained healthcare fraud lawyer or attorney. These are the people to help you prove your innocence and should be used. Find a good healthcare lawyer if you need help with healthcare abuse or fraud.…

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What Are The Potential Penalties For Health Care Fraud And Abuse

Asking the doctor to issue two invoices to get reimbursement of the total amount of the consultation with the health plan or doctors who direct the brand of a particular product to earn commission from a manufacturer are common practices, but constitute a crime. However, these crimes, done by patients, suppliers of drug-medical-hospital materials or even by doctors themselves, only cause harm to consumers, often times leading to the need to hire a health care lawyer. The frauds committed against the health plans, which often only benefit the practitioner itself, further make plans cost more to the beneficiaries.

Omission of diseases

Fraud can start already in the completion of the questionnaire of the plan, when the consumer decides to omit a pre-existing disease. Fraud occurs when people know about the disease, but it omits. People act against the law and believe nothing will really happen to them. This might seem fine, but those who do it often need the help of a Health care fraud attorney to get rid of the issue.

Using someone else’s health plan

When the beneficiary allows another person to use his social security number or any other sort of documentation and see a doctor. Allowing someone to take advantage of the plan is fraud. For this reason, many doctors’ offices and laboratories ask for the original document and photo before carrying out a procedure. In this case, there are two crimes: presentation of false documents and false identity. Click here.

Two receipts for a single appointment

It is common in a doctor’s office to request two receipts, with different dates (separated by more than 60 days, for example), but related to a single consultation or procedure performed. The behavior is very common in the modality “free choice” of professionals, marketed by some plans. In this category, the plan has a limit value per consultation, but in general, it is below the price that some doctors charge when attending private patients. There is an agreement between the operator and the tax authorities, this difference between notes can be traced , leading the need to hire a Health care fraud attorney.

Families create companies to have a business plan

There are increasing cases of families that open up front companies only to achieve adherence to a corporate plan. The modality is cheaper when compared to the collective or individual plans. However, besides being a prohibited maneuver, it is important to warn that the plan could be more expensive in the long term. This is because, if one of the beneficiaries or their dependents face any serious health problem, the monthly fee may increase dramatically, since the group has a small number of people.

Change to higher value of reimbursement receipt

 In this case, the professional asks if the patient wants a receipt with a value higher than the value of the consultation, in this way the beneficiary receives a refund amount greater than the amount paid. The practice, totally illicit, affects daily health plans, which end up having higher expenses and, consequently, the costs with tuition increases. The doctor who is convenient with this practice may have to pay more taxes because there will be divergence in the income tax return. Both patient and clinic might need to get a Health care fraud attorney to sort the situation out. To find out more, check out https://federal-lawyer.com/healthcare-defense/

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Healthcare Fraud Lawsuits; What Is Health Care Fraud? 

Healthcare fraud includes the documenting of false health care claims keeping in mind the end goal to get a benefit or to lessen expenditures on health care costs and you may need a Health care fraud attorney. This type of fraud is very far-reaching and might be proficient by people or by whole elements endeavoring to evade costs related to healthcare inclusion. Healthcare misrepresentation is a general class that spreads a wide range of kinds of fraud, including professionally prescribed medication fraud, Medicare fraud, protecting fraud, and different sorts of misrepresentation.

What Are Some Common Types of Health Care Fraud?

Healthcare misrepresentation claims may once in a while include illegal lead, for example,

  • Filing copy claims-a candidate my document a copied claim, or a claim that is just marginally extraordinary, with a specific end goal to receive double rewards.
  • “Kickback” plans: This is the place the candidate is illegal remunerated for utilizing or supporting a specific kind of treatment, medication, equipment, or benefit, or for giving illegal referrals
  • Fraudulent medicinal charging tricks: For example, cheating or petitioning for overabundance administrations. Requesting for superfluous administrations is additionally unlawful
  • Providing false, data: Making false statements on a healthcare application or claim is, for the most part, thought about infringement and can prompt both private and criminal results
  • Illegal resale: Selling medicines or equipment through a dark restorative market is exceptionally unsafe and can provoke legal consequences, and also wounds to honest people

Because of these kinds of health care fraud, the healthcare business is profoundly managed and is liable to some stringent laws ask your Healthcare fraud attorney. Abusing health care misrepresentation laws can have sweeping ramifications for people and organizations.

What Are Some Legal Penalties for Healthcare Fraud?

Legal penalties for healthcare misrepresentation much of the time include the recording of criminal accusations against the litigant. Numerous wards arrange health care misrepresentation as a kind of salaried wrongdoing, deserving of illegal expenses, and furthermore by conceivable time in a region imprison office. Get a Healthcare fraud attorney to avoid more severe penalties.

Furthermore, some healthcare fraud claims can include different gatherings, including various healthcare suppliers. Standardapplications can likewise be recorded regarding the fraud, particularly if one healthcare organisation has endured financial misfortunes by the misrepresentation. In such cases, the subject gatherings with Healthcare fraud attorney may need to pay the offended party organisation a money-related harms honour to repay them for the misfortunes caused due to the fraudulent claim(s). Check here.

How Might I Avoid Being a Victim of Health Care Fraud?

Health care fraud claims can be maintained a strategic distance from by making a few strides. Comprehend your rights-Hiring a legal counselor can assist you with keeping refreshed with any new advancements in the territory of health care law. Choose an intensity ofHealthcare fraud attorney This will enable you to have a legal delegate to assist you with your healthcare claims if you all of a sudden wind up weakened.

Do I Need a Lawyer for Help with a Healthcare Fraud Lawsuit?

Healthcare misrepresentation claims can be exorbitant and may even include communication with state criminal laws. If you need any health care issues, you may wish to talk with individual damage legal advisor quickly. Your Healthcare fraud attorney can help you in recording a claim appropriately,so you maintain a strategic distance from any violations including fraud or duplicity.…

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Choosing a Physician: Ten Things to Think About

It is very important for you to ensure you have an experienced and competent physician to deal with your illness, assist you when you are being hospitalized and also assist you to stay healthy. A good physician should be able to check your health regularly through routine checkups to see if your healthy is okay. If you have any issue with your physician ensure you contact a health care lawyer for advice. The ten things to think about are:

  1. Review your health insurance policy

This is viewed with the purpose of knowing whether there are any restrictions on the kind of physician to choose. Sometimes you might find a list of approved physicians on your insurance carrier.

  1. Ask yourself about the gender of the physician you want

It is important to mind about the gender of the physician you want if it will make a difference for you. Know whether you want a male or female physician but ensure you choose somebody you will be open to talk to.

  1. Ask your about the age of the physician you want

It is very important for you to mind about the age of the physician you want. Would you like a young physician or an old physician who has experience? A young physician who graduated recently might know more about the current medical practices and technology but they lack experience.

  1. Look whether they are board-certified in their area of specialization

This will depend on whether you are looking for a specialist. A physician who is board certified is one who has taken an extra interest in the carrier and has done a specialist test.

  1. The availability of the physician

The availability of the physician is very important because you might be sick but there is nobody to assist you because your physician is not around. Most of the physicians are busy and they have limited periods that they commit to see patients.

  1. The hours the physician is available must match your availability

Your own hours of availability must match those of your physician so that you can be able to go for checkups without postponing because one is not around. Ensure the physician you choose is available when you are free to see him or her.

  1. Ask about the bedside manner of your physician

Ensure you don’t look for a physician who thinks about business and money but choose someone who takes time to know more about you and your family and someone who discusses life issues with you.

  1. Choose a physician who respects you and your opinions as well

You are the party with the medical need and the physician is the party with the medical knowledge and therefore you must feel comfortable with the physician you are choosing and it should be somebody who is free to discuss your opinions.

  1. Ask for the physician’s track records

The best way in which you can know about the track record of a physician is through contacting the medical licensing authority. They are the ones who can tell you if there are any disciplinary issues. In case of fraud hire a heath care fraud attorney to assist you.

  1. Do you trust the physician?

When you are hospitalized or ill you must be able to put some amount of trust on your physician and if you don’t trust your physician then it means you ask someone with experience to assist you.


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What Are the Potential Penalties for Health Care Fraud and Abuse?

Health Care Fraud

The federal government has been putting in place measures to ensure there is a reduced number of health care fraud and abuse cases. This is due to the increased cases of health care fraud in the past few years. The government has provided education and training to the health care providers to inform them of the various fraud they should not be part of. The government has also put in place laws and measure to help penalize those found guilty. Many people, providers and consumers, have been penalized for health care fraud and abuse. When you are suspected of health care fraud, you have the right to a health care fraud attorney. When found guilty, below are the penalties you make get.

When found guilty of health care fraud and abuse, you can be penalized with exclusion. This is whereby you are prevented from the direct billing of health care products and services. This also includes being banned from working with or having a contract in health care programs provided by the federal government. Exclusion is for a certain period of time. However, when you violate the penalty during the period, you may face an extent in the period of exclusion.

  • Being charged with fraud.

When the case is strong, you may be charged with fraud by the federal court when found guilty of health care fraud and abuse. This is a serious penalty and you may end up in prison. Therefore, when faced with federal investigations concerning healthcare fraud, it is advisable to consult a health care fraud attorney to reduce your chances of being charged with fraud. Whether you are innocent or not, you should ask for an attorney.

Fines are mainly the penalty when you are found guilty of taking kickbacks or fraudulent. The federal government department of health services decides on how much money you should be charged for violating each rule under the anti-kickback rules statue. For fraudulent claims, you are charged triple the amount of losses the government has incurred from your fraudulent activities.

  • Qui tam actions.

The false claims act allows a private party to report a case of health care fraud and abuse. In this case, there are several penalties that you can face. These are the qui tam actions. Legal fees, fines, settlement and recovery are the possible qui tam actions that may be taken.

  • Criminal sanctions.

This is the penalty given when you knowingly commit a health care fraud or abuse. Maybe you were previously found in a health fraud and all the legalities were explained and you still commit the crime. In this case, you are treated as a criminal and face criminal charges. You are jailed for several years or face other severe actions.


To effectively avoid health care fraud and abuse, both the consumers and providers should be involved in eliminating it and taking an ethical stand to avoid abuse in the health sector. Everyone should also understand the penalties and consult a health care fraud attorney whenever there is a problem.…

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How Will You Pay a Medical Malpractice Lawyer?

Cheap health insurance

Let’s face it… no one ever plans to need a health care lawyer. Most times, these types of expenses are not only incredibly stressful but also a total surprise. So, in the event that something catastrophic happens, how will you afford to pay your health care lawyer?

What are some common types of fee arrangements?

Most health care lawyers work on what’s called a “contingency fee.” Basically, what a contingency fee means is that their payment is contingent on winning the settlement or lawsuit. Their fees are they paid out of the settlement money, usually as a percentage of the total. That percentage usually ends up being about 33%, or 1/3rd, of the total to the health care lawyer. If the trial ends in a loss, the lawyer does not receive any money. One thing to consider is who is required to pay the costs of the litigation itself, which can be quite significant. These costs include any expert witnesses needed, as well as the fees of the actual court time itself. In the majority of cases, these fees are taken care of by the health care lawyer, at least at initial onset of the case. Should the case be successful, the health care lawyer may request to also be reimbursed for a portion or all of those costs out of the settlement. Make sure you confirm before hiring a health care lawyer so that there are no surprises at the end of the trial.

What should I consider?

Make sure that you remember that all health care lawyer’s fees are, to some degree, negotiable. Shop around before committing. Get reviews from any friends or family member’s that may have gone through similar situations. Also remember that most health care lawyers will do free initial consultations so don’t feel bad about going in, sitting down, getting a general feel for him or her and thinking on it before signing anything.

Be aware of legal considerations

Recent legislative efforts have sought to restrict the amount of lawsuits that health care lawyers can bring. The concern is that increased lawsuits may actually increase the cost of healthcare as a whole. Before deciding whether or not to bring a lawsuit, consider the laws and statutes in your state. Ask your potential health care lawyer about them as well – they should be up to date on any laws and changes that may affect you and your case to avoid potential fines or worthless lawsuits. Additionally, some states put caps on the percentage that a health care lawyer can ask for from an potential payout. These limitations are non-negotiable, while legal fees are.

If you need to hire a health care lawyer, there are a few considerations to keep in mind to make sure you are following the letter of the law and aren’t being taken advantage of. Health care lawyers mostly work on contingency, so don’t be afraid to shop around and negotiate fees prior to hiring them.


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Is A Health Care Fraud Attorney Really Necessary When You’ve Been Mistreated?


Most people never dream of finding a health care lawyer when they have been mistreated by their doctor or health care professional. It does seem a little odd because most of us trust our doctors and the people who look after us in our time of need. Unfortunately there are a few professionals who are only in this profession for money. Many doctors who aren’t honest try to defraud you out of money and it’s serious to say the least which is why an attorney is needed.

Mistreatment or Fraud On The Part Of the Insurer Is Serious

What happens when you’ve been mistreated by a doctor? What if they charge you or your insurance company for something that hasn’t been performed? That is fraud and while it might seem as though it’s just a few hundred dollars, it can all add up. You really cannot afford to be the victim of mistreatment or even a fraud by the doctor. For this reason, you are going to require the services of a health care professional. A health care fraud attorney will fight for your corner and will absolutely ensure you are treated fairly. This is so important and finding a great lawyer to help shouldn’t be too troublesome.

You Don’t Have To Be Left Out-Of-Pocket

If you have been a victim of a fraud by your doctor or the doctor or indeed the insurance company has mistreated you in some way, it’s necessary to ensure you get fair compensation. However it isn’t just about money but rather getting fair justice as well. This is so important and too many frauds go unpunished by medical professionals. With a good health care lawyer you know your case is going to be taken with utmost care and attention. This is certainly something that is important to thousands and it’ll make all the difference to families as well. Know why !

Finding the Best Health Care Lawyer Is Necessary

When it comes to finding a good lawyer, you have to approach this smartly. You not only have to look at the reputation of the lawyer but how long they have been practicing in this area. If the attorney or lawyer has many years of experience, that is a real advantage as it means they are well adverse in this area of law. Also, you know they are going to be honest with your chances of winning the case. If there isn’t a high probability you’ll win, you will be told about that. In truth is your case may depend on the lawyer you choose. If you don’t find an honest or trustworthy professional then you may be stuck with someone who isn’t experienced enough to take your case. A health care fraud attorney must always have excellent experience to deal with your case.

Get Someone on Your Side

You never know what could happen when facing a lawsuit, whether you are bringing on a health care professional or you are the one being sued. That is why you absolutely must find a professional who can help you. Choosing a health care attorney is really quite necessary in today’s world and they know how to handle these cases extremely well. They know the law and will be able to do the things you can’t. A health care lawyer is a useful professional and they can help you too, check here: http://federal-lawyer.com/healthcare-defense/

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Lawsuit Loans And Settlement Loans: Combating Health Care Fraud And Abuse

Health Care Fraud

Although of fairly-recent origin, lawsuit loans and settlement loans are becoming more widely known. Individuals are relying on various forms of lawsuit funding to assist them in being able to continue litigation against those who cause them harm through health care fraud. In the vast majority of instances, litigation funding can be extremely valuable to individuals who file legitimate claims.

However, for those individuals who are intent on health care fraud, you should be aware of the fact that incorporating various forms of litigation funding will give a second pair of eyes to this situation that may be unwanted!

I realize that it appears incongruous to suspect that there is some logical consistency in what I’ve stated. However, please note that all lawsuits require various levels of scrutiny prior to getting to the final process. If a lawsuit is filed against health care fraud, this typically means that the underlying negotiations have failed. This isn’t always the case. Why? Because some attorneys opted to file a lawsuit as soon as a client comes to them.

When individuals seek lawsuit loans and settlement loans, they are advised to work with brokers who will attempt to connect them with litigation funding agencies that are best-suited to accommodate their needs. Additionally, various jurisdictions limit the types of funding that may be advanced and brokers can be tremendously valuable to applicants.

When applications are filed, many of these funding agencies work closely with health care lawyers and underwriters who have a great deal of experience in reviewing such matters. If fraudulent activity is suspected on a particular file, this may trigger the need to report concerns to law enforcement. Remember, there is no attorney-client privilege in documents being submitted. Therefore, you should be cognizant of the need to reserve this form of funding for those cases that are legitimate.Learn more detailed updates at http://www.seventhcircuitcases.com/dont-fall-victim-to-health-insurance-fraud-3-ways-to-protect-yourself/

Fortunately, the vast majority of cases that are filed are pristine. However, for myriad reasons, some individuals will attempt to take unfair advantage of a defendant through health care fraud. Illustrative of this is the case in which a plaintiff’s car may have only a tiny scratch on it and yet submit bills for tens of thousands of dollars. (Yes, severe injuries can occur in minor incidents. However, they are the exception rather than the rule.)

Keep in mind, lawsuit loans and settlement loans were created in an effort to even the playing field. Plaintiffs customarily must do battle with insurance carriers and their health care lawyer. It isn’t simply a matter of plaintiff versus defendant. In those cases in which no insurance is involved, many individuals find that it’s not even worth their while to pursue compensation for harm they sustained.

Health Care Fraud

The vast majority of cases that we see arise from car accidents. Most states require insurance coverage – by law. Failure to maintain this insurance while operating a vehicle can constitute a crime in most states. Therefore, the vast majority of cases involving car accidents will have a component in which a plaintiff must deal with both the defendant and the defendant’s insurance carrier. Remember, when you deal with an insurance carrier, you are often dealing with very experienced insurance defense attorneys who focus their attention solely on representing insurance companies. (It is true that defense attorneys state that they represent the defendant, not the insurance carrier. However, this is absolute fiction.)

Those in need of lawsuit loans and settlement loans should pursue them with the assistance of a broker. Make certain, however, that your claim is legitimate and you are not causing health care fraud. If you are attempting to perpetrate a fraud, in addition to being advised not to perpetrate the fraud in the first place, you certainly create double-trouble for yourself if you submit these claims to lawsuit funding agencies. If you in any doubt contact a health care lawyer today.…

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Five Physicians Plead Guilty to Health-Care Fraud – An Important Lesson For Physicians


The United States Attorney in Boston recently announced the settlement of a health care fraud case involving five urologists and TAP Pharmaceutical Products, Inc., a major American pharmaceutical manufacturer. The government alleged that the urologists received illegal inducements from TAP to prescribe the drug Lupron in the 1990s. The physicians pleaded guilty to health care fraud, and TAP agreed to pay $875 million to settle allegations of fraudulent drug pricing and marketing of Lupron.Visit my latest blog posted at http://www.seventhcircuitcases.com/dont-fall-victim-to-health-insurance-fraud-3-ways-to-protect-yourself/

TAP markets Lupron for the treatment of advanced prostate cancer. The U.S. Attorney initiated an investigation into TAP’s pricing and marketing of Lupron in 1997, after a urologist employed by an HMO reported to law-enforcement authorities that he was offered an educational grant to reverse a decision he had made on behalf of the HMO to exclude coverage for Lupron.

To induce physicians to prescribe Lupron instead of a cheaper alternative, TAP gave physicians free samples of the drug, worth as much as $40,000, as a form of volume discount. The average cost of a monthly dose of Lupron was $400 to $600. Because Lupron must be injected under the supervision of a physician, Medicare, which normally does not reimburse for medication, reimbursed physicians 80% of their administration cost. The remaining 20% was reimbursed by the patient as co-pay. TAP fully intended and expected the physicians to prescribe the free Lupron to their patients and then bill the patients and their insurers the average wholesale price of the drug. That is precisely what the physicians did.

As a further incentive to encourage physicians to prescribe Lupron, TAP offered them free consulting services, free trips to golf and ski resorts, and money disguised as “educational grants,” that the physicians used to pay for cocktail parties, office Christmas parties, medical equipment, and travel expenses. The Government described these items as kickbacks and bribes used to influence the physicians to prescribe Lupron.

The TAP case is likely to have a significant impact on the marketing practices of not only pharmaceutical companies, but on all health care vendors. For physicians, the message should be loud and clear.

First, physicians need to carefully examine some of the perks they are used to receiving from health care product and service vendors.

The Federal government cited as illegal inducements many of the marketing practices typically utilized by pharmaceutical companies and other health care vendors, including: free products, free consulting services, trips to golf and ski resorts and money purportedly for “educational grants” but used for other purposes. Thus, physicians who accept free services, free products, or money from vendors risk criminal charges and civil liability.


It is known as health care fraud and therefore a felony under the Medicare-Medicaid Anti-kickback statute (42 U.S.C. 1320a-7b) to receive or solicit payment in exchange for ordering an item, such as a prescription drug, reimbursable by Medicare or Medicaid. This statute was expanded to apply to all federal health care programs under the Health Care Portability and Accountability Act (HIPAA).

In terms of civil liability, physicians who knowingly submit false claims for reimbursement by the federal government can incur civil penalties of up to $10,000 per claim, plus treble damages, under the Federal False Claims Act (31 U.S.C. 3729-3732). At $10,000 per claim, civil monetary penalties often reach millions of dollars. For example, TAP’s $875 million penalty included over $559 million to settle its federal civil False Claims Act liability in the Lupron case.

Second, physicians need to realize that the Government is paying close attention to their interactions with manufacturers and vendors of health care products and services. The TAP case highlights the government’s increased vigilance in investigating and prosecuting violations of the fraud and abuse statutes. In a six-month period (April through September 2001), the Government recouped more than $1.22 billion through both Civil Monetary Penalty Law and False Claims Act civil settlements. Physicians should stay tuned to further developments in this area. If you are in any doubts, contact a health care lawyer today.…

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