Rosenblum Schwartz & Fry

Considerations on recent health care fraud operation

We submit in today's blog post that reactions regarding last week's announcement of a health care fraud-related bust of historic proportions might range considerably based on personal perspectives held by differing segments of the population.

On the one hand, of course, state and federal law enforcers across the country who were involved in operations that ensnared high numbers of alleged wrongdoers uniformly laud their undertaking and its result. The initiative -- which reportedly yielded criminal charges against more than 400 medical professionals -- has been described as "the largest health care fraud enforcement operation in U.S. history."

On the other hand, though, and especially since the health care arena is so obviously marked as a realm for the heightened scrutiny of fraud investigators, many industry professionals are likely materially alarmed by recent goings-on and, frankly, running more than a bit scared.

And what is notable is that many of those individuals -- specifically, care providers such as doctors, nurses and pharmacists -- are worried about potential criminal liability even when they are acting in good-faith and with zero intent to defraud anybody.

We reference that reality -- that phenomenon, if you will -- in a recent blog post, noting in our July 13 entry that, "Alleged wrongdoers sometimes get ensnared in fraud-related matters with scarce -- or even no -- evidence that they committed an illegal act with the purposeful intention of doing so."

Criminal investigators -- commencing with U.S. Attorney General Jeff Sessions -- certainly bypass that story line in their reference to the so-called "takedown" that took place last week, with the nationwide bust described above reportedly addressing more than $1.3 billion in fraudulent activities, including an alleged overprescribing of opioid painkillers.

The investigation was ongoing for about a year. Fifty six of the 400-plus individuals criminally charged in the sting were doctors.

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Rosenblum Schwartz & Fry

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