Ten years ago, in the late 1980s, medical care practitioners were mostly concerned with civil litigation, especially medical malpractice litigation. They were constantly involved with administrative proceedings through Medicare/Medicaid reimbursement and other federal pay programs, but this was a billing office matter, not a source of personal constant concern for the physicians and nurses. There were occasional criminal actions against physicians who sold prescriptions for controlled substances and against “Medicaid mills,” but “nice” physicians and hospitals did not worry about criminal prosecution. Suggestions that physicians might face criminal prosecution for what were considered routine business practices were dismissed by most medical care attorneys. [Richards EP, Deters DJ, Gray RJ. Physicians and their profession: do racketeering rules apply? Nat Law J. 1989;38.]

Now, prominent hospitals and medical schools have paid hundreds of millions of dollars in administrative and criminal fines, health care practitioners and administrators have gone to jail, and all hospitals are working on plans to demonstrate compliance with federal law so that they can claim mitigation under the Federal Sentencing Guidelines if they are accused of criminal behavior. Although medical malpractice litigation continues at about the same pace, it has faded into the background as a concern in the face of jail time or the administrative law death penalty: banishment from all federal programs and any facilities that deal with federal programs. It is critical that medical care practitioners understand the special characteristics of the criminal law system and how to protect themselves from liability.