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Feds renew targeting of healthcare fraud

Jun 14, 2023 | News

Alleged scams across the healthcare industry born out of the COVID-19 pandemic have become one of the top targets of the new U.S. attorney in the Philadelphia region. Across the country the U.S. Department of Justice has targeted fake vaccine cards, telehealth fraud, upcoding and other forms of healthcare fraud. U.S. Attorney Jacqueline C. Romero, the Philadelphia area’s top federal prosecutor, told the media that her office of the U.S. Department of Justice will be targeting, among other areas, “upcoding” – the practice of a doctor or healthcare provider billing for a more expensive service than a patient received. The U.S. Department of Justice’s national office further announced in April 2022 it would enhance its targeting of a wide array of healthcare fraud in 2023 and beyond.

The government takes upcoding – and all healthcare fraud – seriously, believing much of it is the result of healthcare organizations purposely over-billing the government or entering into financial arrangements with referral sources that violate the law. The truth is, however, that the government’s complex coding systems and the rush to get appropriate telehealth systems in place during COVID-19 caused a flurry of honest mistakes. With its renewed concentration on detecting and prosecuting upcoding, it seems clear the authorities believe that a large percentage of these errors were intentional acts, or the results of reckless or deliberately ignorant actions – not true mistakes.

Granite GRC delivers governance, risk and compliance solutions to a multitude of industries. Our professionals have spent decades working with companies, their boards and their executive management teams to successfully navigate through the challenges and complexities of government investigations and negotiations, including cases involving allegations of false claims for payment or reimbursement, kickback allegations and Stark law issues. Our services include:

  • Systems and transactions assessments and analyses
  • Consultation, support and performance of internal investigations
  • Forensic evidence collection and analysis
  • E-discovery and data mining
  • Support in drafting and responding to legal documents and inquiries, including depositions, and expert witness testimony

We are also well-known for our work in counseling boards, senior teams and their staff on compliance and compliance program matters.  Learn more about our Investigations, Disputes and Litigation Support practice group.  

If you have concerns about whether you company is well-positioned to address issues with the U.S. government please Jeffrey Miller, attorney and Director-in-Charge of Granite GRC.  We are ready to assist.