☰ Menu
× Close

How Health Care Fraud Impacts Doctors & Medical Organizations

How Health Care Fraud Impacts Doctors & Medical Organizations

You’ve worked hard for your medical degree. The amount of education, sleepless nights, and extra-long shifts are all worth it when you get the chance to truly help someone else. 

Even with the degree, title of “Doctor” ahead of your name, and a list full of satisfied patients, your reputation is still an extraordinarily important asset, and one mistake can have lasting impacts. Throughout your career, you’ll get patients and companies alike that will ask you to do something outside of your comfort zone. This is especially true for new doctors with less experience than seasoned physicians. 

Furthermore, your staff is a representation of you. That’s why it’s critical to provide the proper training and supervision, so you don’t get caught up in an investigation for health care fraud. 

Do you need legal representation for health care fraud? Contact Carson Law today to get started.

Health Care Fraud & How It Affects Physicians

As a doctor or other medical professional, you may be asked to invest in an enticing deal or have a chance to make more money by referring patients to a specific facility or prescribing certain therapies – these can be kickbacks and are illegal. You should always have an attorney who’s experienced in health care disputes to guide your decision before you sign anything.

When you make important decisions without legal advice tied to your practice, employer, or your name, you leave yourself vulnerable to being accused of health care fraud. 

Stay Away From These Risky Schemes

Look out for the following scenarios to protect yourself from losing your medical license.

Uncertain Investments

As a physician, you may be approached to invest in a brand new, state-of-the-art, freestanding radiology facility. It sounds great on paper, you’ve seen the designs, and you have an idea of its advantages. However, it’s extremely essential to move forward with caution as full or even partial ownership contracts could have terms you’re not completely aware of. As an example, those contracts may be set up to include exclusive referral arrangements. Or they might simply include other unspoken terms and conditions that affect your personal practice.

Before you make any kind of decision, talk to Contact Carson Law.

Kickbacks & Referrals

Any kickback deal that sounds too good to be true is exactly that – even if it’s worded differently. Taking payment of any kind that comes from offering unnecessary or incorrect services is illegal. This is also covered by the Anti-Kickback Statute. A few other examples of a kickback payment could be:

  • Gift cards
  • Meals
  • Cash or check
  • Transferred deposits
  • Drug samples

If you are caught taking these types of payments, you face up to five years in federal prison along with a number of other punishments.

Additionally, whenever you’re referring patients to other providers, it’s prohibited to take a referral fee. This is better worded through the Physician Self-Referral Law. There are even restrictions in place that discourage doctors from referring patients to other healthcare professionals they’re related to under the Stark Law without full transparency. If done in secret, it’s seen as a conflict of interest, and you can lose your license over it.

Prescribe Medication By The Book

Remember, the public trusts you as their doctor or healthcare provider to give them the right prescriptions in the correct doses. Even if a close family member or friend asks for extra or free medications they don’t need, it’s your responsibility to say no.

The abuse of prescription drugs is a huge problem in the United States. In fact, 35 million people worldwide have drug use disorders. Even if you have no knowledge of your patient database misusing prescription drugs, it has an impact on your life and your licensing. 

When people abuse prescription drugs, the cost of medicine increases for physicians, insurers, hospitals, and taxpayers. More importantly, prescription drug abuse leads to lives lost due to addiction. This is why it’s important to monitor, be thorough, and track patient progress, especially when you’ve prescribed medications to them.

Double-Check Claims

You trust your team to keep daily operations running smoothly. Nevertheless, employees can make mistakes, and sometimes deliberate decisions, without thinking about how it affects their employer. You’re busy, and that’s completely understandable. However, take some time to review claims and other records when necessary to make sure services rendered on your side are accounted for and with good reason. Unfortunately, false claims do happen, and they can wreak havoc on your practice if you don’t know what to do. Claims are explained more in-depth under the Federal False Claims Act. Ultimately, it says it’s not only illegal but also punishable by several financial penalties.

Know When To Contact An Attorney

Are you being accused of Medicare, Medicaid, or health care fraud? You don’t want to go about fighting it alone. Hire an attorney and have someone who can handle the intricacies of health care fraud law. Having an attorney help dismiss your case brings you closer to the goal of salvaging your reputation and moving forward with your practice. This can only be done through research and strategy from a lawyer familiar with these types of cases. 

You need an attorney to prove you didn’t knowingly and willfully participate in any fraudulent activities because the government, at the state and federal level, does not take health care fraud lightly. Moreover, there are several different governing bodies that lookout for fraudulent activities, including:

  • Department of Justice Healthcare Fraud Strike Force (DOJ/HCF)
  • Health and Human Services Office of Inspector General (HHS-OIG)
  • Federal Bureau of Investigation (FBI)
  • Drug Enforcement Administration (DEA)
  • Local and state Medicaid fraud control units

These massive enforcement units in Texas and at the federal level make their goal identifying and stopping health care fraud. Federally, the Department of Justice (DOJ) and Health Care Fraud Unit (HCF) enforce the regulations against health care fraud. Centers for Medicare and Medicaid Services also look out for fraudulent activities. Doing so allows the centers to continue putting resources in the right hands.

Protect Your Reputation & Your Practice

It’s important to know when to contact an attorney when dealing with concerns regarding health care fraud. Any type of claim regarding health care fraud made against you is one you need to address with the right legal action. 


Set the record straight and contact Carson Law today.