Health care abuses put in spotlight

National headlines have been focusing on health care for months. Now with the passage of President Obama’s health care program, the Department of Justice and Health and Human Services are concentrating their efforts on health care fraud. Attorney General Eric Holder has predicted more health care prosecutions, and to this end, United States Attorney’s offices across the country have set up health care fraud units in their respective offices. The Attorney General has made the elimination of health care fraud a priority for the Department of Justice. He estimated health care fraud has cost taxpayers $63 billion.

These offices will not only focus on civil enforcement against fraud and health care but will seek criminal charges where appropriate. What does this mean to the Grand Rapids health care community? The expansion of health care services in the greater Grand Rapids area, including the development of the Medical Mile in downtown Grand Rapids, the opening of the Michigan State University College of Human Medicine, the development of the Lemmen-Holton Cancer Pavilion, Helen DeVos Children’s Hospital, Spectrum Hospital (Butterworth), Meijer Heart Center, Van Andel Institute, plus the expanded services and commitment to health care by Saint Mary’s and the Metro Health systems will not go unnoticed by the investigative eye of the federal government. 

The government will be particularly interested in allegations of Medicare and Medicaid fraud. The U.S. Attorney’s Office in Grand Rapids has created a health care investigative and prosecutorial unit and has assigned two assistant U.S. Attorneys who will coordinate their efforts with the FBI and agents from Health and Human Services, investigating civil and criminal allegations of health care fraud.

If the government is successful, violators could face fines, court costs, and in some cases, penalties tripling their reimbursement from the government. A criminal conviction could lead to loss of doing business with the federal government and, for individuals, the real possibility of prison.

Health care professionals need to be vigilant in complying with the health care laws. Compliance programs, consultations with lawyers and other knowledgeable health care professionals are a must to avoid the risk of failure to comply with the law.

James S. Brady is office managing member of the law firm Dykema’s Grand Rapids office and the leader of the firm’s national white-collar practice area. His practice is concentrated in the areas of business and commercial litigation, white collar investigations, criminal law, health care fraud and environmental and energy law.

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