Breaking Down the Role of Prosecutor in Health Care Fraud Cases

Posted on: March 5, 2007  |   Author: Kelly Dineen
Filed Under: Fraud & Abuse   |   Comments Off

Jim Sheehan, Associate U.S. Attorney and national expert in health care fraud, recently visited the School of Law to discuss his practice. As a federal prosecutor for nearly 30 years, he did a wonderful job of breaking down the role of the prosecutor in a health care fraud case. In describing the unique undertone of the health care relationship and why we are particularly shocked by fraud in this context, Sheehan explained “there is a trust relationship between doctor and patient that is very different from the relationship between a customer and a used care salesman.”

Sheehan began his presentation by showing a past segment of “60 Minutes” that described an elaborate scheme that allowed a physician to collect hundreds of thousands of dollars in clinical research money for sham investigations. Once the students heard the set up, Sheehan explained how difficult such cases can be to prove, despite the most egregious of circumstances. Despite underhanded actions, a prosecutor must show a loss of money to win a fraud case and in the context of clinical research where no insurance company or patient is paying for care, successful prosecution can be challenging. Sheehan accurately noted that “behind every case like this, there is a failure of systems-a failure to watch and a failure to monitor.”

Sheehan was incredibly enthusiastic about his work and the student response was positive. So much so, that Sheehan and a number of students had to move to another classroom to extend the question and answer session. In describing what he loved most about his work in health care, Sheehan explained that it is always interesting and ever changing - “there is not an American alive that doesn’t have an opinion about health care,” he said.