Defenses for Dialysis Clinics Being Accused of Fraud

If you or your dialysis clinic allegedly committed health care fraud, it will be important to have a defense for your alleged actions.

Like most allegations, there are various defenses that can apply to health care fraud. Defenses are case and fact specific. Many times one of the strongest defenses is that you did not have the state of mind that is required to violate a criminal statute. For example, it would be that you did not knowingly make a fraudulent statement to defraud a health care benefit program.

Depending on the statute, there can be numerous defenses available to you. For instance, the Stark Law has a handful of safe harbors that could apply to your referral that would help determine that it was not a financial relationship according to the statute.

Working with an experienced defense attorney will help you to establish a defense for your case, this can help to get your case dismissed or result in lesser sanctions and penalties.

Dialysis Clinics and Health Care Fraud in the News
Article 1: False Claims of  Drug Administration to Dialysis Patients Results in Health Care Fraud Settlement[1]
In 2013, U.S. Renal Care out of Texas, and their dialysis clinic out of Plano, Texas was alleged to have committed acts of health care fraud. As part of these allegations, a qui tam lawsuit was filed under the whistleblower provisions of the False Claims Act.

From their investigation, the United States government alleged that from January 2004 to May 2011 the clinic falsely submitted claims to the Medicare program for administering the drug Epogen. While the drug was being administered, the amount being claimed was higher than the real amount administered.

As part of these allegations, the United States government clarified that the vials that contained the drugs also had an excess amount to compensate for any amount that might remain in the vial after being extracted by a syringe and in that may also remain in a syringe.

Essentially, the United States government found that the clinic billed for this excessive amount in addition to the normal amount. In the end, U.S. Renal Care decided to settle the civil case. As part of that settlement, U.S. Renal Care agreed to pay $7.3 million.

Article 2: Medicare Fraud, Kickback Scheme Between Dialysis Clinic Employee and Ambulance Results in Guilty Pleas[2]
In 2017  former employees of a Los Angeles dialysis clinic pleaded guilty to health care fraud for their role in a kickback scheme that involved false claims to Medicare for ambulance and transportation services for the five individuals they were treating even when the individuals did not need the ambulance services.

One of the administrative assistants at the dialysis clinic pleaded guilty to conspiracy and health care fraud by admitting to conspiring with the dispatcher of an ambulance company. This conspiracy was to refer patients for ambulance services, and in return, the administrative assistant received cash kickbacks.

The dispatcher for the ambulance company also pleaded guilty to conspiracy to commit healthcare fraud for sending ambulances in response to the fraudulent request and for submitting around $6.6 million in claims to Medicare as part of the unnecessary transportation services. Records show that Medicare paid for $3.1 million worth of those claims.

As part of their guilty pleas, all five individuals who were involved agreed to pay restitution to Medicare.

Article 3: Nationwide Dialysis Clinic Pays Millions In Fines For Kickbacks[3]
In 2014, one of the nations largest health care providers for dialysis settled the claims made against them for committing health care fraud by violating the False Claims Act by getting involved in a large kickback scheme.

In the case against DaVita health, the United States government alleged that during the period ranging from March 2005 to February 2014, DaVita had researched and identified various health care providers throughout the county who had patients in large numbers that were suffering from renal disease.

After identifying these health care providers, DaVita offered them profitable deals to partner with DaVita by selling or acquiring the dialysis clinics to where the patients would be referred for treatment. As part of this agreement, the health care providers agreed not to compete, in which they would only refer to the DaVita dialysis clinics.

This is another example of a lawsuit brought by a private citizen under the qui tam/ whistleblower provision of the False Claims Act. When those lawsuits are filed, a citizen initiates a lawsuit for the United States government. At a later time, the United States government takes over the lawsuit.

This lawsuit results in DaVita agreeing to pay $350 million in fines to resolve the allegations against them.

How To Protect Yourself If Your Dialysis Clinic Is Being Accused of Health Care Fraud
While all health care practitioners should be taking steps to help eliminate health care fraud and avoid accusations, as a dialysis clinic the many different people you deal with make accusations unavoidable.

If you have been accused of health care fraud, you should review your actions to determine where the accusations stem from. If you are unsure, it is in your best interest to get advice to determine whether you are actually committing health care fraud.

Sometimes, it is too late to avoid accusations, and you find out at the time you are sued or charged with health care fraud. If you find that you are being sued or charged, it is important to contact an experienced defense attorney to review your case and for legal representation.