It depends. Medical space and equipment rental arrangements between physicians and landlords are considered to be safe harbors, which are protected by the Federal and New York State Anti-trust Statute. But it is not uncommon for providers or their landlords to step out of line and not complies with the safe harbor provisions.

To comply with the safe harbors, health care providers must enter into a written rental agreement for space and equipment, the charges must be set in advance at fair market value, and not by referrals, percentage of Medicare or Medicaid payments, or federal or New York State insurance reimbursements.

Failure to comply with the safe harbor provisions could spark an investigation for insurance fraud by the New York State Attorney General’s Office.

Commonly investigated cases often involve providers who just started practicing medicine; these newly minted providers enter into an agreement with his/her landlord to rent a space for an incredibly low rent in exchange of 30% of his Medicare and Medicaid claims. In such cases these providers are often unaware that by doing so, they are conspiring to commit insurance fraud, and have violated the Federal and New York State Anti-kickback Statutes.

If you have been arrested or investigated for violating the New York State Anti-kickback law or for healthcare fraud , then call our Long Island healthcare criminal lawyers at (516) 204 7611 to get professional legal advice.

H.E.A.T., which stands for Health care fraud prevention and Enforcement Action Team, is a joint program of the Department of Justice and the Department of Health and Human Services. It was introduced in 2009 as a national attack on health care fraud. Specifically, it oversees actions of the Medicare Fraud Strike Force, a team that works to investigate and charge health care fraud offenders at the federal level.

This initiative reflects the intensified approach that prosecutors have adopted in recent years: they’re turning up the “heat” and they want you to know it. Recent investigations have snared unprecedented numbers of offenders and you need to make sure that you aren’t next. If you have been caught, you need to know how to respond effectively. This article can help you understand how to do just that.

Broadly defined, health care fraud is any attempt to unjustly benefit from a health care fund like Medicare or Medicaid. This offense could include any of the following: billing for services not actually rendered, performing and billing for services not medically necessary, billing for a more complex procedure than the one really performed (also known as “upcoding”), billing separately for procedures that should have been billed together (“fragmentation” or “unbundling”), and similar unlawful practices.

In short, if you tried to get public health care money that you didn’t truly earn, it was probably health care fraud.

The people behind H.E.A.T. hope that their efforts will have an effect of deterrence upon those who would otherwise commit health care fraud. Now that prosecution is up, you’re more likely to get caught and so you might be less likely to engage in questionable practices. Nonetheless, H.E.A.T.’s primary objective is to enforce anti-fraud laws and punish those who have already broken the law.

Targets of H.E.A.T. investigations have included New York health care professionals. In New York, Medicaid is run at both the state and federal level but Medicare is strictly a federal program. Consequently, for fraud linked to either program, you could face federal charges and so H.E.A.T. could therefore be involved in your case.

If you have received a letter from investigators that cited your health care billing and instructed you to respond, you may be an H.E.A.T. target.

If you know you’ve been billing Medicaid or Medicare more than you should have been, H.E.A.T. could be investigating.
This is not to scare you, but rather to help you become informed and prepared. If you think you may be facing H.E.A.T. for health care fraud charges, you need to take a deep breath and then call an expert defense attorney. Your attorney can mitigate undesirable outcomes and ensure the best results possible.

To avoid any possible self-incrimination, do not talk to investigators directly. Instead, retain a good attorney and let him do the talking for you.

The ideal course of action is of course to avoid health care fraud in the first place, but many have had a fraud indiscretion and lived to tell the tale. If you may be facing an issue with H.E.A.T. or any aspect of health care fraud in Long Island, simply call our Long Island health care fraud defense attorneys at 516.204.7611 as soon as possible.

Essentially no. The act of billing Medicare under a Medicare certified office when in fact the supplies were provided in an unauthorized office as of yet, still constitutes Medicare fraud. Even if both the certified and pending certification medical offices are owned by the same person, the claim is still deemed fraudulent.

It is also important to note that even if the pending office eventually gets certified, that the claims that were previously submitted under a different clinic is still considered to be criminal false claims by the Office of Inspector General (OIG).

Why? Because at the time of the submittal, the pending office was still unauthorized and when the provider submitted the claim under a different clinic, there is allegedly intent and knowledge in scheming to defraud Medicare.

Since the beginning of the year 2007, the federal government created the Medicare Fraud Strike Force to specifically investigate on Medicare fraud. Even if the medical provider is billing under a Medicare certified office while conducting the services in a pending Medicare certified office seems to fall under a grey area at the time, the OIG, and more specifically the Medicare Fraud Strike Force will not hesitate to launch a full-scale investigation once an investigator sees a discrepancy within the clinic’s billing process.

Under such a situation, it is certainly daunting for the alleged offender to face, and he/she may feel obligated to submit any information the investigator requests. This may not be such a good idea for the alleged offender to follow through. Instead, he/she should speak with a skillful and experienced federal criminal defense attorney specializing in healthcare fraud to see what steps are necessary to take in order to optimize his/her defense.

At Joseph Potashnik & Associates, we have a panel of some of the most skilled federal criminal defense attorneys specializing in various areas of health care fraud defense.

If you are being investigated or arrested for Medicare fraud or healthcare fraud in Long Island, call our Long Island Medicare fraud lawyers at (516) 204 7611 to get professional legal advice.

Predating and backdating involve manipulating the dates of entry on insurance billings and medical records, so they look as if the medical assessments were made on certain days when they were actually not. Usually, medical billers use these methods to insure maximum coverage of the provider’s assessment by the patient’s insurance company.

When predating a medical record, the date of the entry on the Super Bill or medical chart will predate the date of the actual assessment. When backdating a medical record, the date of the entry on the Super Bill or medical chart will be dated after the date of the actual assessment.  While as simple as these methods may seem, predating and backdating medical records, may constitute as a form of healthcare fraud in the eyes of federal and state government agencies.

Practitioner need to be aware that by modifying or altering entries date in a medical record or Super Bill with intent of misrepresenting the facts, he/ she may be liable for larceny by false pretenses, offering a false instrument and/or falsifying business records.

With today’s rapid adaptation of electronic patient charting, and billing and coding software, it is easier for investigators to find discrepancies between the date of entry on the patient’s chart and that of which was on the E-bill.

Government and private insurance companies tend to conduct routine peer reviews or audits of the provider, and request for a copy of his/her medical charts. Discrepancies are usually found at the onset of this stage. Sometimes doctors will blindly comply with their record request, and incriminate themselves afterwards.

Prevention is usually the best way to go. At the beginning of a fraud investigation, it is best to seek an experienced defense counsel for a consultation on what to do next.

If you are recently being audited by an insurance company in Long Island, then call our Long Island health care fraud defense lawyers at 516.204.7611 to get professional legal assistance.

A physician commits both professional misconduct and a crime if he or she knowingly and willfully solicits or receives anything that has a value that is given to affect a provider’s referral decision or a beneficiary’s choice to self-refer. A physician who is convicted of illegal remuneration may be subjected to denial of payment for referral services, five years of imprisonment and a fine of no more than $25,000.

Although the Anti-Kickback Law’s definition of illegal remuneration covers a broad composition, the statute and regulations do contain several “safe harbors”/ business arrangements that do not violate the statute.

Some of these “safe harbors” include

• Investment Interests and Investments in Group practices- Physicians are not entirely barred from investing in other health care entities to which they refer patients to.
• Space Rental and Equipment Rental
• Personal Service and Management Contracts
• Sale of a practitioner’s practice
• Referral services
• Warranties
• Discounts that are property disclosed
• Payments made to bona fide employees
• Waiver of beneficiary coinsurance and deductible amounts

“Safe harbors” provisions are restrictive and are each subjected to different regulations. In order for some physician’s business arrangements to qualify as a “Safe Harbor”, specific requirements for the provision must be met.

If you are recently being investigated or charged for illegal remuneration in Long Island or New York, then call our Long Island healthcare fraud defense attorneys at 516.204.7611 to get professional legal assistance.

As of more recent news, civil audits and criminal investigations of health care providers have become more aggressive due to the growing number of federal and state investigative agencies. New York State has separately appointed a Medicaid Inspector General to coordinate the many fraud and abuse control agencies. These agencies are provided with a multitude of resources and authority into investigating alleged health care fraud and abuse cases.

The Stark Law

One of the more recently amended laws in the Federal system is the Stark Law, also known as the federal physician self-referral laws. Under the new Stark Law, referrals amongst physicians, health care entities and “designated health services” are prohibited and can be subjected expensive penalties.

These “designated health services” includes clinical laboratory services, physical therapy services, occupational therapy services, speech & language pathology services, radiology services, durable medical equipments and devices, home health services etc.

The Stark Law generally prohibits medical providers from issuing patients referrals to designated health services that are reimbursable by Medicare and/or Medicaid if the provider or the provider’s family has a financial relationship with that entity (direct/indirect ownership/ investment interest or compensation arrangement).

The financial relationships between the physician and the entity can vary and can also be an exception to the Stark law.

Penalties

Although violation of the Stark Law is considered health care fraud, it is not a criminal statue. Penalties does not include imprisonment but it does carry severe and expensive penalties such as exclusion from Medicare and Medicaid, civil monetary penalties up to $15,000 per bill, and an assessment of more than 3 times the amount claimed for each item or services.

If a physician has reason to believe that he/she is confronted with a federal investigation for violation of the Stark Law in Long Island, it might be neccessary to consult with our experienced Long Island health care fraud defense attorney at (516) 204-7611.