59. When Opinion Becomes Crime: Doctors and Medical Fraud

Doctors have been suspected, accused, or convicted of fraud since time immemorial. But, in the era of third-party payment for health care, such charges have taken on an entirely new form, particularly when the third party in question is the federal Medicare program. How does the government proceed to establish that Medicare fraud has taken place? How does it distinguish fraud from poor judgment or incompetence? And what does that mean for the practicing physician who submits thousands of claims a year to Medicare?

To help shed light on the legal procedures, tactics, and tricks that can send a physician to a federal jail, our guests are Kyle Clark and Andrew George, defense attorneys who specialize in white collar crime and healthcare fraud.  Clark and George work for the global legal firm Baker Botts, LLP, and they recently authored an op-ed in the Wall Street Journal on this subject entitled “A Second Opinion Becomes a Guilty Verdict”.