Legal Services for Radiology 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 a radiologist have all been handled by our firm before. If you have any questions or need representation for your radiology clinic or any of your legal needs, contact our experienced attorneys.
How are radiology clinics held liable?
There are some common mistakes radiology 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.
Health care fraud charges have been ever prevalent with the federal government and with these charges they are also going after radiology 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 radiology clinics?
As a Radiology 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 a radiology 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 my radiology clinic liable for fraud?
Radiology 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.
How do the actions of the clinic I work at impact me?
Workers at a radiology clinic need to make sure that they are insulated from any claims of fraud. If you believe that your clinic or the people at your clinic are being investigated 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.
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.
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 is “Health Care Fraud?”
Generally, 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.
The Federal Health Care Fraud statute, 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 the “False Claims Act?”
The False Claims Act provides criminal and civil liability for knowingly making submitting false records or claims to the government. Any fraudulent payments that go through Medicare and Medicaid can be prosecuted under the false claims act.
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 punishments might I face under these laws?
Penalties for Illegal Kickbacks
If you are found guilty of getting a kickback under the federal Anti-Kickback 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.
Penalties for Health Care Fraud
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.
Civil and Criminal Penalties for Submitting False Claims
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.
What Does the Government Have to Prove In A Prosecution for Illegal 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.
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 to defend it in the best possible way.
I Was Not Involved In the Scheme, But My Employees Were
When the federal government investigates a radiology practice, they may end up charging individuals who were not directly involved in the scheme but had a nexus to the scheme.
For instance, as a doctor, the government may try to prove that you had knowledge of a fraudulent scheme being carried out in your office by one of your technicians.
The prosecution may think that you have knowledge or information related to the fraud that may be useful to them in their investigation.
If you were not directly involved in the fraudulent practices, you should have your attorney review your clinics practices in order to show compliance.
The Radiology Clinic That I Work For Committed Fraud, Am I Liable?
When your radiology 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 knew 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.
What are some cases against Radiology Clinics?
$3 Million Health Care Fraud Case Against a Radiologist
In Florida, the owners of the Midtown Imaging and PBC Medical Imaging clinics had to pay out $3 million in order to resolve claims against them under the False Claims Act. There were several agreements in place that were violating The Anti-Kickback law and the Stark Law.
Between 2000 and 2008 the clinics operated in a way to defraud Medicare and Medicaid. This type of fraud that was performed lead to an investigation after a whistleblower suit. They only faced civil charges, but there is a possibility for these type of actions to result in criminal charges.
The federal government was tipped off to the fraud through a whistleblower suit. As a result of their actions of blowing the whistle, two workers received $600,000.
14 and a Half Year Prison Sentence Handed Down to the Owner of a Radiology Clinic
When you commit fraud, there is a possibility of serving a long sentence. A man in Florida ended up having to serve 14 years in prison for his fraudulent schemes. David Lovelace was found guilty of charges of a conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to commit money laundering, money laundering and aggravated identity theft.
It was approximated that there were about $12 million in false claims that were filed through his companies. Some of the claims included fraudulent claims to Medicare for radiology services. At the end of the trial, he was found guilty and sentenced to 174 months.
$2.4 million forfeiture to be paid by Long Island Radiology company
Zwanger-Pesiri Inc., a radiology company in Long Island, pleaded guilty to two counts of health care fraud. With the plea deal, they agreed to forfeit $2.4 million and were ordered to pay $8 million to resolve civil cases against them.
The criminal forfeiture involves payments to be made to the federal government or state for criminal penalties, and $2.4 million is a very large penalty. In total, they needed to pay out over $10 million for this fraud case.
Between 2009 and 2014 the radiology clinics were performing multiple services such as x rays and a bone scan when it was only necessary to perform one of these. There were multiple different instances where they were double billing and trying to make money from insurance companies which lead to their case against them.
What should you do?
As a radiology 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.