Every year, we hear about the costs of health care going up, issues related to medical malpractice lawsuits, issues related to private insurance, problems with public insurance driving up medical costs, and greedy corporations purchasing patents to drive up the costs of accessible medicine. But one thing that seldom gets discussed in terms of the costs of health care is healthcare fraud.
Health care fraud works in a number of different ways. Typically, however, it isn’t much different than other forms of fraud. In the case we’re about to discuss, the individual and their company is accused of ordering prescriptions that never made it to their patients. They did this so that they could drive up their insurance costs. The pharmacy company that handled the prescriptions makes money for nothing, and the individual who oversaw the health care of the patients takes a kickback for funneling business their way.
Is patient brokering really illegal?
Health care groups often work within networks nowadays. They will only make referrals within the network. While some doctors have blown the whistle on this practice after being fired for making out-of-network recommendations to patients, the practice remains more or less legal. Like most fraud or white-collar crimes, it seems like this happens all the time and no one really cares about it. But patient brokering is a crime. We just need to understand what specifically is criminal about it.
Essentially, a doctor or health care worker is not allowed to receive payment for making their patients accessible to another health care company. As an example, if I run a group home and one of my residents falls off the wagon, I may have a relationship with an inpatient hospital, but I would not be allowed to charge that hospital for access to my group home patients. Additionally, I wouldn’t be able to create a bidding war between hospitals to treat patients in my care. That specifically is the type of relationship that is considered “patient brokering” and is illegal. However, neither real patient brokering nor its legal alternative tends to provide the best care for patients as doctors are routinely prohibited from making out-of-network referrals even when one doctor is a legitimate expert in his field.
Now, of course, it’s illegal to charge insurance for prescriptions that never existed and were charged to clients who never received them. Yet this is exactly what happened. Even if there wasn’t a separate statute for patient brokering, the defendant would be guilty of insurance fraud, health care fraud, and administrative violations of the duty of care to his patients which could result in the suspension of his company’s ability to accept Medicaid or Medicare, which would essentially shut down the business.
Talk to a West Palm Beach Criminal Defense Attorney
If you are facing charges, you will need a reliable West Palm Beach criminal defense attorney with years of experience fighting for those charged with crimes in court. Call The Skier Law Firm, P.A. to schedule an appointment and discuss your situation in greater detail.
Resource:
palmbeachpost.com/story/news/crime/2021/12/19/west-palm-beach-addiction-treatment-official-mark-sanchez-pleads-guilty-patient-brokering/8910094002/