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Civil RICO Claims Against Healthcare Practitioners

Originally designed to tackle organized crime, RICO Claims (the Racketeer Influenced and Corrupt Organizations Act) have since expanded their application. In the realm of civil disputes, the civil RICO statute has encompassed the healthcare industry. A civil RICO claim focuses on establishing consistent racketeering tied to an entity. 

The expansive and multifaceted healthcare environment in California, paired with its rigorous regulatory framework, has become a magnet for these legal actions. Increasingly, insurers from other states are utilizing RICO civil suit mechanisms to bring cases against California medical professionals. 

Some insurers use RICO civil lawsuit procedures because they can potentially circumvent conventional state oversight mechanisms, accelerating settlements. The provision in RICO that multiplies damage compensations is an additional incentive, promising higher payouts. Medical practitioners should be wary of these maneuvers and seek specialized legal advice when confronted with such challenges.

Protect Your Practice Against RICO Claims

  • Periodic Billing Scrutiny: Ensure billing processes are both accurate and in compliance with all regulatory bodies.
  • Staying Up to Date on Rules: The medical regulatory environment is in flux. Regular updates can avert unintentional breaches.
  • Clear Channels with Insurance Providers: Promptly address and resolve any concerns to deter further complications.
  • Legal Oversight: Engaging with a legal expert in healthcare to evaluate practices can pinpoint and rectify potential weak spots.

Being one step ahead can mitigate potential legal entanglements in a civil RICO lawsuit. Implementing stringent oversight, equipping staff with the latest in billing and coding standards, and cultivating open dialogues with insurance entities can minimize the risk of RICO-related challenges. Additionally, affiliating with professional groups and partaking in seminars can keep professionals updated on the shifting sands of healthcare legislation.

Examples of Civil RICO Disputes in Healthcare

Understanding the practical applications and instances of a civil RICO lawsuit can offer clarity to medical practitioners. Below are some examples of what these lawsuits might potentially address:

  • Fraudulent Billing Practices: A clinic or healthcare provider might be accused of consistently overbilling patients or insurance companies.
  • Kickbacks and Referrals: A medical professional might be alleged to have received financial kickbacks for referring patients to certain medical facilities, laboratories, or pharmacies
  • Unnecessary Medical Procedures: A healthcare practitioner might face a RICO lawsuit if they’re accused of consistently recommending and performing unnecessary medical procedures to inflate billing.
  • Prescription Fraud: A doctor or group of doctors could be accused of repeatedly prescribing medications, especially controlled substances, without medical necessity, and possibly receiving kickbacks from pharmaceutical companies.
  • Misrepresentation of Services: A medical establishment may provide one type of service but bill it under a more expensive code, misleading insurance companies and receiving higher reimbursements. 
  • Falsification of Medical Records: Systematically altering medical records to justify unnecessary treatments or to bill at higher rates could be another ground for a RICO lawsuit.

Understanding these examples helps medical professionals remain vigilant and ensures that their practices are not inadvertently crossing lines that could lead to litigation. Regular audits, training, and legal consultations can help prevent such situations from arising.

Speak to a RICO and False Claims Act Attorney

Civil RICO claims are very serious matters. Whether they are being alleged against your practice or you want to take steps to ensure your practice isn’t doing anything to warrant these claims, speaking to a RICO and False Claims Act attorney can help you get a better understanding and take precautionary or responsive steps. 

Fenton Jurkowitz Law Group litigators have successfully defended RICO and False Claims Act lawsuits against healthcare providers. The firm regularly represents both plaintiffs and defendants in complex RICO and False Claims Act litigation. Fill out our contact form to connect with a RICO and False Claims Act Attorney.