No, I don't have big weekend plans. And it's a slow pre-holiday weekend news day. So, let's talk healthcare and the Medicare "charting party" case unsealed this week in the SDFLA. DOJ's Medicare Strikeforce has indicted 3 doctors and 17 others, in what the government has dubbed the "nation's largest mental health racket," alleging that unneeded group therapy sessions and sleep studies were being routinely provided at several community mental health centers. Judge Seitz, whose courtroom was my second home as a young AUSA, has drawn the case. The charges stem from an ongoing probe into Miami-based American Therapeutics Corp. Last October, the company and four executives were charged with defrauding Medicare out of more than $200 million dollars. The government claims that medical records were altered at "charting parties" as part of the scheme. [Ok, it's not the go-go "Cocaine Cowboys" days.]
Having spent a lot of time defending and prosecuting health care cases, this case stands out to me for a few reasons. First, doctors have been arrested. You don't see doctors charged very frequently and the stakes could not be higher for them. A conviction, in almost all likelihood, will cost them their medical license and livelihood (not to mention debarment from Medicare). Second, the government is going after medical services provided to patients that are alleged to be unnecessary. Such medical necessity cases focus on medical judgment and proving criminal intent on the part of the physician can be difficult. In the case of mental health services like group therapy, where diagnoses are not black and white, it is even harder. As a defense lawyer, those are facts I like.
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