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Hi I'm Tony Munter, I'm an attorney at Price Benowitz and I want to talk today a little
bit about health care fraud.
Many people get angry when something goes wrong with their health care, but that doesn't
always make it fraud. Fraud in health care is a special area. I want to talk to you a
little bit about what constitutes a False Claims Act case in fraud. Its not medical
malpractice, its not when your doctor makes a mistake. Its when a health care organization
or a company is in the business of making more money, and puts business ahead of health care and acts like it.
There's a lot of different ways that they may do this. A billing department may upcode,
that's the terms we use when they charge for a service that's substantially more complicated
than what they actually provide the patient.
There's lots of different ways that pharmaceutical companies and other organizations may provide
services or kickbacks to get more business.
There's an anti-kickback statue, and a stark law, and these laws were created to prevent
business interests from polluting the actual care provided to the patient.
Health care fraud is not about a mistake. If your doctor makes a mistake that may be
terrible, and it may be another issue, but doctors and hospitals who are in the business
of really providing health care, and are sincerely pursing the health of their patients, have
nothing to fear from the False Claims Act. Its those organizations that want to treat
Medicare and Medicaid like their own personal piggy bank that should be scared of a False
Claims Act action.