In case your company is caught up in a federal workers’ compensation lawsuit, the first thing you should do is to inform your lawyer. This will enable him or her to immediately start to prepare your defense and prevent possible indictment.
Common grounds for federal workers compensation
• Abnormal modifiers meant to increase collection
• A high volume of patients
• Unfair marketing practices to members of a union
• Billing for services not rendered
• More than required therapy sessions
• Unlawful cooperation with processors of current claims
• Lack of required medical supervision
• Using unqualified employees to carry out billing
• Unlawful free services to patients
• Use of Chiropractors or massage therapists
All of the above cases can trigger an inquiry or investigation from the federal government investigation agencies. Some of the issues might appear simple but can result in license cancellation, search warrants, and criminal prosecution.
It is not advisable to wait until you are placed under investigations before you take appropriate action. However, if it ever reaches that point, you should immediately contact an experienced lawyer to discuss the next course of action.
Unlawful marketing practices involving federal employee patients and the Department of Labour (DOL) billing fraud cases are normally investigated and charged under 18 U.S.C. 1374.
The statute states that it is criminal for anyone to get involved in schemes designed to steal money from healthcare programs funded by the federal government such as the Department of Labour or Medicaid.
Violations of any of the terms stated in this act can lead to a prison term of up to 10 years and fines amounting to $250,000 or more.
You definitely won’t like such a punishment. Engage legal expert or lawyer as soon as possible to avoid regrets.
How will you know if your business is being investigated for fraud?
In most cases, the investigating agency or agencies will inform you about pending or ongoing investigations.
You may receive a notification or call from the Department of Justice, Office of the Inspector General, Federal Investigation Bureau, or any other investigation agency from the federal government.
However, most people tend to ignore the fact that they are being investigated – believing that they haven’t committed any crime or offense. This can be dangerous because you might have committed an offense unknowingly in the course of your operations and was discovered by the investigators.
The prudent thing to do is to talk to a lawyer as soon as you are contacted or suspect of investigations.
Signs that your business is under investigations
• Staff or patient interviews – If you find out that any of your patients were interviewed by federal agents, then is likely that the government is suspecting fraud in your business. Investigators always want to get first-hand information from patients.
• Undercover investigators – The other thing you are likely to experience is the presence of undercover investigators from the federal government. Some of them will disguise as patients and ask you a lot of questions.
• Search warrant or subpoena – Unlike the first two signs that might be difficult to notice, a subpoena or search warrant is a clear indication that you are under investigation.
Penalties for healthcare workers compensation fraud
If it is proved that your clinic or organization is guilty of workers’ compensation fraud, then you are bound to face punishment. The penalties may include a jail term or monetary fines.
For example, one business owner in New York was sent to jail for three years after investigations proved that he received over $83,000 in form of benefits that he wasn’t qualified for.
The investigations also found out that the employer did not have workers’ compensation coverage for his employees.
Another example took place in 2019 when several businesses including several marketing companies in Texas and North Carolina entered into a civil settlement under the False Claims Act after they were accused of participating in a healthcare fraud scheme.
There are several other companies that are still being investigated across the country for getting involved in workers’ compensation healthcare fraud.
When the law enforcement officers come calling, the best thing is to ensure that you have a strong defense team to rebuttal the fraud allegations.