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This question on defendant side. I like to know what options available to reduced consequence. The person is a dentist. He practiced himself and then owned several his dental business and operated for more than 20 years. He is absentee owner in his business. He hired contractors (dentist) to see patients. A lot of the patients are in Medicaid program. He recently sold two of his last dental business. From the sale, the business buyer uncovered the following and reported to government. In order to treat patients in Medicaid program, a dentist is required to be credentialed by Medicaid besides having a regular dental license(dental board). Furthermore, if a dentist prescribes strong pain medicine(controlled subtance), the dentist needs to have DEA license. But one or two of the dentists he hired either was not credentialed by Medicaid or had DEA license. In order to keep the business running, he used his own DEA license and medicaid credential to submit billing to Medicaid to get re-imbursement. Strictly speaking, this is false billing or in violation of Medicaid/DEA regulation. Now, he is facing civil lawsuit(from business buyer), and Office of Inspector General is investigating. The OIG may bring criminal charge to him. His conduct violated false claim act. However, his situation may not be as bad as those fraud that billed government healthcare but not render services. He rendered services. An answer from a guy from KY attorney general earlier said he may more likely face admistrative correction or education correction. But the OIG guy who is collecting evidence indicates to bring criminal charge. Any comment and if there are any exception that he can get less consequence. He did this on a couple of his practice business. Is it easy to prove he knowingly cheat? He is currently avoiding the civil lawsuit (charge of breach of contract/fraud) services. The government is collecting evidence to bring charge to him.
The answer is really very simple. He had a number of businesses so he can't claim that he was surprised as to what was going on generally. More importantly, he had a responsibility to make sure that the dentists were properly credentialed before they treated patients. And finally, the "smoking gun" is that he had to use his own credentials, knowing that the dentists involved didn't have them. I'm afraid the government will have a strong case against him. I would also be concerned that the dentists will turn state's evidence against him. He needs a really sharp lawyer to minimize the outcome.
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Thanks. Could he face jail term? He could have funded his IRA or other retirement asset with the money received this way. But it is very hard to quantity how much. Heard if the plaintiff can prove fraud and the IRA was funded (partially), the plaintiff may go after his retirement asset to recover loss. Will the judge decide whether his IRA be touched or not if he has no other assets left?
On the civil side, you mean even his IRA or retirement asset (except social security) can be sized to satisfy the judgement.
What I heard before is that if the IRA was funded from fraud money, the court/judge can decide to exempt or not. If this is true, let say the defendant fraud earned $20k and $10k of them is fraud money. He has IRA founded from the $20k, will half of the IRA are not exempt?
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