Implications for Health Care Practitioners
The most important implication of the Federal Sentencing Guidelines is that they erase the traditional deference toward professionals who are accused of “technical” crimes such as Medicare fraud. Medical care practitioners who are accused of crimes can expect to be held to higher standards because of their special skills and relationship with the patients. This reflects the importance the courts attach to the fiduciary aspects of the provider patient relationship. In their role as caregivers, providers must be careful to follow the applicable federal and state laws regarding their relationship with the patients and other providers.
As managers and supervisors, medical care practitioners must ensure that their institution has a compliance plan that meets all the criteria of the Federal Sentencing Guidelines. More important, the plan must actually work and deal with the problems of the institution. The existence of the plan is not a defense to criminal prosecution, it is only a mitigating factor in the punishment for the violations. A successful compliance plan must prevent the violations if it is to protect the institution and the providers involved with the regulated activity. A medical care practitioner can be found liable for the actions of others whom the provider relies on: if your billing service is submitting fraudulent bills to Medicare for your services, you are on the hook because you have a nondelegable duty to ensure that every claim you submit is proper. If you believe the compliance plan is not working, but do nothing to report or change it, you can be liable for failing to prevent the criminal activity of those under your supervision.