Regulation of Antitrust and Fraud in Health Care

Regulation of Antitrust and Fraud
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Regulation of Antitrust and Fraud
Elements of the Case
The case pertains to a legal suit where the defendants were found guilty of defrauding the U.S government of $60 million through falsified paperwork (Department of Justice). The money in question was reimbursement under the Medicaid and Medicare program in which Novus Health Services submitted claims for hospice services that were not offered. In addition, the company was found guilty of recruiting practitioners and healthcare institutions to obtain patients’ information regarding their eligibility for hospice services in exchange for money. Each of the 16 defendants in the case was found guilty of at least one count of conspiracy to commit fraud which carried a sentence of 10 years in federal prison and an additional $250,000 fine. The FBI-conducted investigation also found that the institution illegally forced nurses to overdose patients with morphine and other prescription drugs to capitalize on profits. The incident remains the largest expose in the country that affected the Medicaid and Medicare program. In the indictment, falsifications were confirmed through paperwork that confirmed that medical staff members were attending to patients while they were not. In general, the case affected doctors, pharmacists, home healthcare providers, and patient recruiters charged with billing for equipment never sourced and medical services that were not provided or were unnecessary.     
Types of Fraud and the Laws Broken
The individuals found guilty were charged primarily with the intent to defraud the Medicaid and Medicare program that was established to provide equitable and affordable healthcare to citizens. This naturally falls under the country’s professional fraud category, which explains why the Fraud Strike Force was involved in the case. The case is a classic example that applies to the False Claims Act in terms of the law. The act is a statute that informs criminal and civil penalties for illegal billings to the U.S government and includes overcharging for products and services, under-stating an obligation, and any other offense categorized under the act (Halabi, 2016). The justice department primarily enforces the Force Claims Act, although private parties may implement it in exceptional cases. Another law that the defendants broke was the Federal Anti-Kickback Statute. The statute prohibits individuals from soliciting unwarranted remuneration from federal healthcare programs, whether knowingly or unknowingly (Gore, 2020). It is an intent-based statute that seeks to regulate transactions in government-funded health programs to minimize fraud while at the same time maximizing the quality and cost-effectiveness of such programs. Other applicable laws include any law that informs sanctions and enforcement of antitrust statutes as relevant to healthcare (Showalter, 2015).   
Penalty and the Appropriateness of the Outcome
In terms of the penalties for the individuals found at fault, each person faced up to 10 years in prison and a minimum fine of $250,...