Legal Services For Orthopedics Clinics
The Health Law Group has extensive experience representing orthopedists charged with healthcare fraud. Orthopedists can face a wide variety of charges and be subject to excessive penalties. Our criminal defense attorneys know how to stand up to prosecutors and ensure our clients receive the most favorable outcomes possible.
Our firm offers entirely confidential and risk-free consultations and would be honored to assist you with whatever questions or concerns you might have.
We understand the health care industry and will provide you with the assistance and guidance you need during an investigation into your practice.
What Types of Fraud Can Orthopedists Be Charged With?
Healthcare fraud committed by orthopedists can take a number of different forms, including:
- the illegal receipt of kickbacks;
- submitting claims for services not rendered;
- unbundling services in order to increase reimbursements;
- and more.
Orthopedists often face charges in connection to injury assessments, which can qualify patients for certain health care benefits.
In addition, the frequency with which orthopedists provide pain medications places an additional spotlight on them; as the opioid epidemic has led to increasing governmental focus on curbing its devastating effects.
If you are an orthopedist who is facing healthcare fraud charges, if you are concerned about potentially incriminating conduct, or if you simply want to remove all possibility of future liability, we are here to help.
The Controlled Substances Act (CSA)
When orthopedists abuse their prescribing power, charges can arise under the Controlled Substances Act (CSA). The CSA is a federal statute which regulates the manufacture, importation, possession, use, and distribution of addictive substances.
The act classifies drugs into five different schedules under the CSA, depending on their accepted medical purpose, their potential for abuse, and how likely they are to cause addiction.
The chart below provides a general overview of how the CSA classifies controlled substances:
Severe Physical and Mental
Severe Physical and Mental
Severe Mental, Moderate Physical
Mild Mental or Physical
Mild Mental of Physical
Common Charges Brought Against Orthopedists Under the CSA
CSA charges against orthopedists commonly arise due to the fact that orthopedists treat painful injuries, perform surgeries, and are often in the position of lightening the impact of treatments and procedures by prescribing opiates. Medications such as oxycodone have been notoriously abused by patients, leading to an alarming number of deaths and fueling governmental efforts to eradicate the causal factors.
While orthopedists are legally permitted to prescribe opiates, under 21 U.S. Code § 841, it is illegal to knowingly or intentionally manufacture, distribute, and dispense a controlled substance in violation of the procedures set forth in the CSA. CSA procedures require, among other things, that prescriptions for controlled substances be issued only in response to legitimate medical need.
The following acts may expose you to liability:
- Failure to spend time with a patient in accordance with medical community standards,
- Failure to sufficiently endeavor to assess the patient’s pain level, or
- Failure to otherwise prescribe these powerful medications with due care.
Indeed, many orthopedists have been investigated and even charged with CSA violations despite a lack of criminal intent.
Sentencing Under the CSA
Under the CSA, sentencing depends in part on the degree of harm that resulted. If your casual overprescription of opiates resulted in patient death, your sentence upon conviction will likely be increased.
Additional Sentencing Considerations
Additional sentencing considerations include the degree of criminal intent involved, prior convictions, and the amount of money defrauded from healthcare benefit programs, amongst other factors.
False Reports and False Claims Submitted By Orthopedists
In addition to the CSA, orthopedists are commonly charged with healthcare violations when they help patients receive benefits they are not in fact entitled to. By falsely reporting evidence of qualifying injuries, orthopedists can help patients defraud their employers and insurance plans, while at the same time increasing the number of reimbursements they receive.
The False Claims Act
The False Claims Act (“FCA”) makes it illegal for Orthopedists to knowingly make a false statement on a claim submitted to a public or private health care providers. This includes a false statement in connection with all services rendered, including treatments, fittings, or products sold to patients.
Orthopedists who are found in violation of this statute will be charged with a felony and will be subject to a $250,000 fine, five years imprisonment, or both, for each false claim made.
Best Defenses to Charges of Fraud Against Orthopedists
Whether you are ultimately granted an acquittal, dismissal, or a plea deal depends on your specific circumstances. Whatever the outcome, you can rest assured that our team will fight to get you the best results possible.
Lack of Intent (“Good Faith”) Defense
Intent is a crucial element in most healthcare fraud statutes, which must be demonstrated by the prosecution beyond a reasonable doubt in order to reach a conviction. Because intent is a subjective state of mind, lack of intent is one of the most commonly raised defenses in cases against orthopedists.
As a result, our criminal attorneys begin working to establish gaps and inconsistencies in the evidence against you from the moment you retain us. Our goal is to instill uncertainty of success in the prosecutor’s mind, increasing the likelihood that you are offered a favorable plea deal in short order, or even that your case gets dismissed.
Who Investigates Charges of Health Care Fraud Against Orthopedists?
The federal agencies involved in investigating charges of health care fraud include:
- The Office of the Inspector General (“OIG”);
- The U.S. Department of Health and Human Services (“HHS”);
- The Department of Justice (“DOJ”) Health Care Fraud Unit;
- The Federal Bureau of Investigations (“FBI”) Health Care Fraud Unit;
- The National Insurance Crime Bureau (“NICB”);
- The Coalition Against Insurance Fraud (“CAIF”);
- The National Association of Insurance Commissioners (“NAIC”)
Generally, federal, state, and local agencies will join forces in order to investigate allegations of health care fraud.
Even private insurance carriers play a role in the investigations. Once a health care provider or insurance carrier initiate an investigation into your practice, they are obligated to inform federal, state, and local agencies of any fraudulent activity they become aware of.
Health Care Fraud Cases Involving Orthopedists
While most health care fraud cases involving orthopedists generally involves prescribing and/or billing unnecessarily, you can face a wide variety of additional charges, as the cases below demonstrate.
Orthopedist Fraud Involving 28 Co-Conspirators
In 2013, orthopedist Peter Lesniewski was found guilty for his part in a healthcare scheme which cost the federal government hundreds of millions of dollars. Lesniewski conspired with over 28 defendants.
The scheme created false paper trails qualifying Long Island Railroad workers for disability benefits they were not in fact entitled to. Lesniewski received cash payments as well as health insurance reimbursements for unnecessary testing he performed.
Lesniewski was convicted of conspiracy to commit mail fraud, wire fraud, and health care fraud, as well as conspiracy to defraud the Railroad Retirement Board (RRB). He was sentenced to 8 years in federal prison as a result.
In 2017, Fred Joseph Turner, a Florida orthopedist, was charged with conspiring to distribute controlled substances for no legitimate medical purpose, dispensing controlled substances, and conspiring to smuggle an alien into the United States.
Turner operated a pain management clinic with a former anesthesiologist which primarily functioned to prescribe excessive addictive pain medications to patients. The clinic rarely conducted examinations and did not take patient drug screens into account before issuing prescriptions.
The scheme was uncovered after undercover DEA agents posed as patients. One agent was paid $5,000 and prescribed high doses of addictive pain medications after he agreed to smuggle a Hungarian national into the United States.
Turner and his co-conspirator revealed a glimpse into their deceptive practices when they instructed the undercover agent to falsify his patient history in order to justify the increased opiate prescriptions.
Turner was sentenced to 12 years and 7 months in federal prison and ordered to pay a $232,020 money judgment.
Please do not hesitate to take advantage of our entirely confidential, 100% risk-free consultation. There is no reason why you should go another day in uncertainty about your future and how to best protect yourself.
If you have been charged with any kind of healthcare fraud as an orthopedist, our attorneys are here to help you.
Knowing that our clients are facing the possibility of years in prison, the loss of their medical practices, fines, and irreparable damage to their reputations drives us to provide the kind of service we would want if we were in their shoes.You can count on us to work diligently for your best interests.