TriCare Cracking Down on Healthcare Fraud and Abuse
Providers servicing military populations and accepting TriCare should be wary: TriCare and the Department of Justice are ramping up efforts to crack down on TriCare
Ronald W. Chapman II, LL.M.
Shareholder
Chairperson of White Collar Defense & Government Investigations
Michigan Office
1441 W. Long Lake Road, Suite 310
Troy, MI 48098
Phone: (248) 644-6326
Providers servicing military populations and accepting TriCare should be wary: TriCare and the Department of Justice are ramping up efforts to crack down on TriCare
Our Medicare fraud attorneys obtained a reinstatement of billing privileges for a laboratory audited for billing for unnecessary services where there were alleged “credible allegations of fraud.”
Prior to the government obtaining an indictment against our client, we thoroughly discussed the case with prosecutors and were able to obtain limited immunity for our client in exchange for his cooperation with the investigation.
OIG guidance requires that health care entities institute sufficient controls to prevent fraud waste and abuse. This includes receiving reports of suspected health care fraud,
Professionals:
Physician
Urgent Care Clinic
Primary Issue:
Our client owned a busy urgent care clinic in Southeast Michigan. The Michigan Attorney General sent undercover patients into our client’s clinic and determined that our client was billing for services that were not rendered. As a result, our client was charged with racketeering and conducting a corrupt enterprise (more commonly known as RICO) and was facing a significant term of jail, significant fines, and loss of his medical license as well as his business.
How We Helped:
In cases such as this, our role is to minimize the damage to our client as much as possible and to protect our client’s assets, medical license, and freedom. While we did not dispute that some services were billed in error, we did dispute that the entire practice was corrupt. Many times, Blue Cross Blue Shield and other commercial insurance carriers who are involved in investigating health care fraud will use health care fraud allegations as a means to profit from criminal action against physicians by requesting large amounts of forfeiture through exaggerated fraud calculations. We could not let this happen and fought aggressively to show Blue Cross Blue Shield and the prosecutors that the charges were exaggerated. We combed through the files and examined the patient care to determine that the amount billed in error was exaggerated by the prosecution. We met with the Attorney General’s health care fraud task force several times to negotiate a successful resolution, and we were ultimately able to obtain a resolution that was satisfactory to our client.
Result:
As a result of our efforts, we were able to obtain a settlement for our client that resulted in no jail time and he was only required to repay the amount billed in error.
Areas of law:
Healthcare Fraud
Health Care Audits
Federal Criminal Defense
Disclaimer:
This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.
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Ronald W. Chapman II, LL.M.
Shareholder
Chairperson of White Collar Defense & Government Investigations
Michigan Office
1441 W. Long Lake Road, Suite 310
Troy, MI 48098
Phone: (248) 644-6326
Providers servicing military populations and accepting TriCare should be wary: TriCare and the Department of Justice are ramping up efforts to crack down on TriCare
Our Medicare fraud attorneys obtained a reinstatement of billing privileges for a laboratory audited for billing for unnecessary services where there were alleged “credible allegations of fraud.”
Prior to the government obtaining an indictment against our client, we thoroughly discussed the case with prosecutors and were able to obtain limited immunity for our client in exchange for his cooperation with the investigation.
OIG guidance requires that health care entities institute sufficient controls to prevent fraud waste and abuse. This includes receiving reports of suspected health care fraud,
Michigan OFFICE
1441 W Long Lake Road
Suite 310
Troy, MI 48098
T. 248.644.6326
F. 248.644.6324
CALIFORNIA OFFICE
5250 Lankershim Blvd.
Ste. 500
North Hollywood, CA 91601
T. (818) 287-0576
FLORIDA OFFICES
6841 Energy Court
Suite 120
Sarasota, FL 34240
T. 941.893.3449
701 Waterford Way
Suite 340
Miami, FL 33126
T. 305.712.7177
Practice Areas
Attorneys
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