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Alice H. Martin, U.S. Attorney for the Northern District of Alabama

Every U.S. president's administration focuses on certain initiatives. Under the Bush Administration, the Department of Justice has cracked down on healthcare fraud, in particular the physicians who commit fraudulent crimes.

"I think [the Bush] administration is appropriate in its aggressive stance against healthcare fraud," said Alice H. Martin, U.S. Attorney for the Northern District of Alabama. "Sometimes people do things without knowing they've crossed legal boundaries. Others willfully violate the law. We're taking aggressive action against the willful offenders."

Over the past several years, the case load in Alabama's Northern District has increase 250 percent, Martin said. Of the 93 districts in the United States, her district is eighth in the nation based on the number of civil healthcare cases filed. Some of the areas that have filed more cases include Manhattan, Philadelphia, New York City and Dallas. "We're high on the list for the size of our city, but we do have a large medical community here so these crimes are a considerable focus in our office," Martin added.

The most prevalent crimes being committed by physicians in Martin's district include fraudulent Medicare billing — up coding, overcharging, and mischarging — and falsification of data on Federal Drug Administration (FDA) drug studies. According to statistics, what's happening in her district is representative of the rest of Alabama. "We also see false label marketing where drug representatives encourage the use of a prescription drug for something other than what the FDA has approved it for," said Martin. "Another nationwide problem is over billing by durable medical equipment providers. We've had cases where you take the population of a county and count up the number of prescriptions for this equipment, and everybody in the county should have one."

In an effort to deter the commission of these and other healthcare crimes, the U.S. Attorney's office has pushed for stricter penalties for convicted offenders, penalties that include prison time, restitution and fines. For example, Alabama physician Dr. Anne Campbell of Gadsden was convicted in 2004 of mail fraud when she falsified data related to the number of people studied in a clinical trial for a new antibiotic drug. She sent the false data by mail to Aventis Pharmaceuticals Inc., the company that sponsored the study. In addition to being sentenced to 57 months in prison, Campbell was fined $557,251 and was given three years of supervised release after completion of her prison term. She was also ordered to make restitution to Aventis in the amount of $925,774. Martin said they always ask that the offender pay restitution to the victim first before paying any fines to the government.

"I'm pleased that we're able to prosecute these physicians and that they're going to prison," said Martin. She added that they are also using debarment, which is becoming a big deterrent to these crimes. "Debarment is a death sentence for a medical practice, because the physician can no longer participate in Medicare or Medicaid programs," Martin said. "Also, the Drug Enforcement Agency can bar them from writing prescriptions."

Martin is proud of the government's success in imposing meaningful penalties for healthcare crimes. In the past six years, the U.S. government has been successful in the civil enforcement of an average of 86 percent of these cases. Of those, only 2.8 percent went to trial while the others were settled by pleas.

"Imposing stricter penalties is helping deter these crimes," she said, "because word gets around and others become more careful. They are deciding that the extra money just isn't worth it."

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