Legal Services for Oncology Clinics
Our group of experienced attorneys has years of experience in handling all forms of health care related charges. The charges you may face as an oncologist have all been handled by our firm before. If you have any questions or need representation for your oncology clinic or any of your legal needs, contact our experienced attorneys.
Call 844-239-1234
for a Free Confidential Consultation
How are oncology clinics held liable?
When you are dealing with cancer patients, the government and most courts will come down hard on you for any fraud scheme because they will take it as you taking advantage of people with cancer. Some of the mistakes that oncology clinics make that put them in civil and criminal liability including billing for practices that are not necessary, billing when no work was done, and even misrepresenting what work was done on the patient
The charge of health care fraud charges has been ever prevalent with the federal government and with these charges they are also going after oncology clinics. When you do the accounting work for a health company, you need to be aware of the fraud charges that you may face.
What are common criminal charges against oncology clinics?
As an Oncology clinic, you need to make sure you are following the law, or you may be charged with any one of several criminal laws. The more common charges against an oncology clinic include kickbacks, health care fraud, and false claims. These three charges can end up with you in jail or facing financial penalties.
What could make me liable for fraud?
Oncology clinics need to make sure that their billing practices and their referrals are done in a way that does not violate the law. When you submit bills to an insurance company, it always needs to be for services that you performed.
One major preventative tool that is used to combat health care fraud is the whistleblower reimbursement scheme that pays individuals who come forward with evidence and sue providers for fraud. The whistleblower may get between 15-30% of all money received through penalties for fraud violations.
When do you face these charges?
If you or your practice are actively participating in a fraudulent scheme, it might impart to you some liability for the actions. As a clinic, the actions of others that you oversee or your own actions could lead to potential liability. For kickbacks, if you are referring clients or paying for referred clients, you might also face these charges.
How do the actions of the clinic I work at impact me?
Workers at an oncology clinic need to make sure that they are insulated from any fraud claims. If your clinic or people at your clinic are in trouble for fraud, you should work to insulate yourself from any potential fraud charges. It is important to understand if you are following the law and do not know or have no way of knowing fraud is going on you have a valid defense to any fraud charges. Additionally, if you are under investigation, you should work with a lawyer to go through what your actions where and what you know to come up with your best defense.
What is “Health Care Fraud?”
Health care fraud involves sending bills to an insurance company fraudulently, in an attempt to make more money than what is owed for the services you provide. Health Care Fraud 18 U.S. Code § 1347 makes it illegal to attempt to defraud any insurance company, and several schemes fall under this such as; double billing, billing for services not rendered, or receiving kickbacks.
What is a Charge Under the False Claims Act?
Any fraudulent payments that go through Medicare and Medicaid can be prosecuted under the false claims act.
The False Claims Act provides criminal and civil liability for knowingly making submitting false records or claims to the government. As an accountant, if you send these entities any false bills, you may be able to be held liable, even if you are acting on behalf of a doctor.
The violation of the False Claims Act means you may either knowingly or unknowingly be held liable under this law. This law is extremely broad and covers several forms of false records. This means that you may be charged even if you don’t know your nursing home is committing this type of fraud, but you should have.
What is “Health Care Fraud?”
Health care fraud involves sending bills to an insurance company fraudulently, in an attempt to make more money than what is owed for the services you provide. Health Care Fraud 18 U.S. Code § 1347 makes it illegal to attempt to defraud any insurance company, and several schemes fall under this such as; double billing, billing for services not rendered, or receiving kickbacks.
What is a Charge Under the False Claims Act?
Any fraudulent payments that go through Medicare and Medicaid can be prosecuted under the false claims act.
The False Claims Act provides criminal and civil liability for knowingly making submitting false records or claims to the government. As an accountant, if you send these entities any false bills, you may be able to be held liable, even if you are acting on behalf of a doctor.
The violation of the False Claims Act means you may either knowingly or unknowingly be held liable under this law. This law is extremely broad and covers several forms of false records. This means that you may be charged even if you don’t know your nursing home is committing this type of fraud, but you should have.
What are Kickbacks?
If you are found to have a contract or receive any values for giving patients referrals, you may be found guilty under this law. The violation must be proven to be knowingly, which means that you must know you are getting some payment for your referral.
42 USC § 1320a-7b(b) outlines what a kickback is and that receiving a kickback is a felony. The act of receiving a kickback is defined as knowingly receiving any money of any kind for a referral. The term “money” is extremely broad and covers payments, discounts, debt forgiveness, and most things that can be given a monetary value.
What Punishments might I Face Under These Laws?
The offense of Health Care Fraud comes with a sentence that includes jail time up to 10 years and criminal fines up to $250,000. If any of your patients are injured your sentence can increase to 20 years, and if someone dies, you may face life in prison. If you are not providing the proper care for your patients and you are billing for that care, you may face a long sentence.
The civil penalty under the False Claims Act is $11,000 for each false claim plus up to three times the damages to the government for the claim. The criminal liability under this law can be assessed only if someone knowingly makes a false claim, and the criminal punishment is a fine up to $250,000 and up to 5 years imprisonment.
If you are found guilty of getting a kickback under this statute, you may face up to 5 years imprisonment as well as criminal monetary penalties up to $25,000. This crime is a felony conviction which means you will be afforded a trial to prove your guilt. In addition to criminal penalties, you may face civil penalties to remember the federal government for payments made on services involved in the kickback.
How Can I Fight These Charges?
We will be able to fight for you to defend you against these fraud claims. Our firm will help you get to the bottom of your case and determine what defenses are available to you. For defenses, it is important for us to know the facts of your case to determine how best to be able to defend it.
I was not involved in the scheme, but my patients were victims of fraud:
When the federal government investigates a practice, they might end up charging individuals who were not involved in the scheme but had a nexus to the scheme. For instance, as a doctor, they might impart knowledge to you of the scheme even if you did not know about it. You should have our attorneys review your work to show compliance.
The practice I worked at committed fraud, am I liable?
When your oncology clinic is committing fraud, and you work at the practice, it is important to set straight what your role in the fraud scheme was. If you were not involved and know nothing about the fraud, you might be safe from charges. If you unknowingly participate in the fraud but did not know nor could you reasonably find out you might also have a defense. We will work with your specific situation to insulate you from the actions of those around you.
Call 844-239-1234
for a Free Confidential Consultation
What does the government have to prove for a Kickback?
It is important to get ahead of any charges by proactively ensuring you are not in violation of the Anti-Kickback Statute. Contact an attorney to review all of your contracts and practices to make sure you are in compliance. If you are not in compliance, an attorney may be able to help remedy any current noncompliance problems that you are facing to avoid future liability.
There are certain exceptions to the Anti-Kickback Statute which may relieve you of criminal liability. If you are trying to export any of the legal exemptions, it is advised to first speak to an experienced criminal healthcare lawyer. They will be able to analyze what you are doing and provide a legal evaluation and risk analysis of any arrangements you enter into.
What are Some Cases Against Oncology Clinics?
Farid Fata’s 45 years in Prison for Unnecessary Chemo
Farid Fata, an oncologist, was sentenced to 45 years in prison after his scheme to give chemo to patients in higher doses than necessary and even to patients who otherwise were entirely healthy. The case came about after Dr. Soe Maunglay found out about the fraud while working with Fata. Following his discovery, he blew the whistle which lead to the investigation and prosecution of Farid Fata.
The sentence handed out ended up being 45 years in prison for multiple counts of health care fraud, kickbacks, and money laundering. In addition to the sentence, he was required to forfeit $17.6 million.
The level of fraud and deceit from Farid Fata to treat cancer patients who did not have cancer and were otherwise healthy with chemotherapy was considered to be egregious. Due to the nature of his crimes the court took into consideration when handing out such a long prison sentence.
$2 Million to a Whistleblower for Blowing the Whistle on $26 Million Dollar Fraud
Qui tam, or whistleblower lawsuits, are ever prevalent in today’s society with the possibility for whistleblowers to make a large amount of money if they help to find fraud against the federal government. 21st Century Oncology’s Vice president of finance blew the whistle on his company stating that they were violating the Stark Law.
The whistleblower found out that the company was filing false claims to the government and helped to compile evidence against 21st Century Oncology. Due to the efforts of the whistleblower and the federal investigation a settlement was reached where 21st agreed to pay out $26 million under violations of the False Claims Act.
$11.5 Million Settlement of Fraud Claims
SightLine a Texas-based organization that has oncology practices throughout the US agreed to settle a false claims lawsuit for $11.5 million. The settlement came in 2018 for actions in 2011. The company set up a kickback scheme that rewarded physicians for referrals.
The company decided to put in place agreements with physicians for them to invest in their company and once they invested, they would be able to get a base of the profits. This type of scheme is not allowed under US law because it sets up a system where physicians have an increased incentive to refer clients to radiology.
When physicians are referring clients the only matter at issue should be the wellness of the patients and when there is a financial incentive introduced you can end up having patients referred for monetary gain. Because of this scheme, the company needed to pay back $11.5 million to the federal government.
What Should You Do?
As an oncology clinician you need to make sure you are in compliance, and if you are being charged or investigated, you should contact our experienced attorneys to help you through this process. The investigations, questioning, and trials are all important parts of this case, so you need an attorney to represent you through each step.