Health care fraud: recent developments and timeless advice

Health care fraud has gained increased attention at both the state and federal levels in recent years. The $875 million criminal settlement by TAP Pharmaceutical Products, Inc, in October 2001 and subsequent indictments of physicians involved with the alleged HCA Medicare fraud conspiracy highlight the fact that physicians who are unaware of any wrongdoing may get dragged into the government's battle. The various laws and overlapping enforcement agencies can be complex and daunting to a physician who is falsely accused. This article provides a brief overview of three relevant federal health care fraud statutes: the Prescription Drug Marketing Act, the Medicaid Anti-Kickback Statute, and the False Claims Act. The article also briefly discusses the Texas Medicaid Fraud Prevention Act and the roles of various state agencies responsible for the detection and prevention of health care fraud. Finally, the article provides practical advice about the investigate process and what every prudent physician should do if under investigation.