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Health Care Fraud Charges: Why You Need an Aggressive White Collar Crimes Lawyer

By Spodek Law Group | October 20, 2023
(Last Updated On: October 21, 2023)

Last Updated on: 21st October 2023, 08:37 am

Health Care Fraud Charges: Why You Need an Aggressive White Collar Crimes Lawyer

Being charged with health care fraud can have serious consequences. Even if you are innocent, fighting the charges can be an uphill battle without the right legal representation. Here’s why you need an aggressive white collar crimes lawyer if you are facing health care fraud charges.

What is Health Care Fraud?

Health care fraud refers to intentionally deceiving or misrepresenting information to obtain money from health care benefit programs like Medicare or Medicaid. It also includes defrauding private health insurance companies.Some examples of health care fraud include:

  • Billing for services that were never provided
  • Billing for more expensive services than were actually provided (called upcoding)
  • Performing medically unnecessary services just to generate insurance payments
  • Falsifying diagnoses to justify tests, surgeries or other procedures
  • Prescription fraud like doctor shopping or altering prescriptions
  • Identity theft using someone else’s insurance information
  • Kickback schemes where doctors are paid to refer patients for certain services

Both individuals and corporations can be charged with health care fraud. Doctors, nurses, pharmacists, medical equipment suppliers, and insurance company employees are common targets. But patients can also be charged for things like prescription fraud or doctor shopping.

Why Are Health Care Fraud Charges Serious?

Health care fraud charges shouldn’t be taken lightly. Here are some reasons why:

  • They are felonies – Most health care fraud offenses are felonies under federal law, punishable by substantial fines and years in prison. Even misdemeanor charges can mean jail time.
  • Your career is at risk – For medical professionals, a conviction can mean losing your license and livelihood. Even if you avoid jail time, you may not be able to work in health care again.
  • Large fines are common – Health care fraud fines can easily reach hundreds of thousands or millions of dollars. You may have to forfeit assets or pay back triple the amount you allegedly obtained by fraud.
  • Jail time is likely – Federal sentencing guidelines impose stiff prison sentences for health care fraud convictions. Even first-time offenders often spend years behind bars.
  • Reputational harm – Allegations alone can devastate your professional reputation, even if you are never convicted. Patients, colleagues, and employers may lose trust in you.
  • Civil liability – Health care fraud charges often lead to related civil lawsuits seeking financial damages, on top of any criminal penalties.
  • Administrative sanctions – For medical professionals, civil fines, license suspension, and exclusion from federal health care programs are possible.

Why Do I Need an Experienced White Collar Crimes Lawyer?

Facing complex health care fraud charges is daunting without an attorney who knows how to navigate these cases. Here’s why you need an experienced white collar crimes lawyer on your side:

  • They understand the complex laws – Health care regulations like Medicare rules are dense and confusing even to lawyers. An experienced attorney will understand the nuances that could make or break your case.
  • They’ve handled health care fraud cases before – Every case is unique, so prior experience is invaluable. A lawyer who has defended health care fraud charges will know the right strategies to employ for your situation.
  • They know how prosecutors operate – Insight into prosecutors’ tactics and the investigative process allows skilled defense attorneys to exploit weaknesses in the government’s case.
  • They can argue intent was lacking – Proving intent to defraud is required for conviction in most cases. Your lawyer may be able to show you made an honest mistake rather than intentionally committing fraud.
  • They work to minimize penalties – Even if some charges stick, an aggressive lawyer can often negotiate reduced fines, probation instead of jail time, and avoid license suspension or exclusion.
  • They are comfortable in court – Most health care fraud cases end in plea deals, but if yours goes to trial, you want an attorney with extensive litigation experience.
  • They have resources to call upon – Top white collar defense firms have networks of health care experts, private investigators, and other professionals they can utilize to build the strongest case for you.

How Can a Lawyer Defend Me Against Health Care Fraud Charges?

A skilled white collar crimes attorney has many options to mount an aggressive defense against health care fraud allegations:

  • Scrutinize the evidence to identify legal violations, procedural mistakes, or other opportunities to get charges dismissed
  • Interview witnesses to poke holes in the prosecution’s version of events
  • Bring in independent medical experts to review records and justify billing or treatment decisions
  • Argue you acted in good faith and lacked criminal intent to defraud
  • Point out errors in coding or billing were mistakes, not intentional deception
  • Challenge the constitutionality of investigative methods like search warrants
  • Allege prosecutorial misconduct like withholding exonerating evidence
  • Negotiate plea bargains to lesser charges to reduce penalties
  • Seek variances from sentencing guidelines based on extenuating factors
  • File appeals challenging convictions, sentences, or procedural errors
  • Petition for early release once sentenced if you behave well in prison

Having an experienced white collar crimes attorney in your corner levels the playing field against federal prosecutors. They have the skills and determination to protect your rights, freedom, and reputation.


Facing health care fraud charges is extremely serious and requires specialized legal representation. An aggressive white collar defense lawyer understands the complexities of these cases and exactly how to build the strongest case for you. Don’t leave your fate to chance – contact a top health care fraud defense attorney as soon as possible if you are under investigation or facing charges. With an experienced legal advocate on your side, you have the best possible opportunity to achieve the most favorable outcome.














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