HEALTH CARE FRAUD CHARGES LAWYERS
Health Care Fraud Charges
Health care legislation is convoluted because there is no single law that governs healthcare fraud. Instead, medical providers are forced to navigate numerous laws to avoid both criminal and civil charges for such crimes as health care fraud, anti-kickbacks, referrals, and false claims. As a defendant, you could face charges under any combination of these laws. Severe consequences can ensue, including incarceration, steep fines, and loss of your medical license.
Health care fraud charges customarily involve a physician, a clinic, or other health care provider who may have charged for items or services that were either not actually provided to a patient or were not medically required. The majority of health care fraud cases are based on fabricated bills submitted to Medicare, Medicaid, TRICARE, or private insurers. That said, some charges may originate from whistleblowers who report illegal activity including patients, office staff, competitors, hospitals, or ex-business partners.
Some Examples of Health Care Fraud:
- Fabricating certificates of medical necessity for the purpose of billing services
- Unbundling and upcoding
- Falsifying plans of treatment or medical records to substantiate payments
- Misrepresenting diagnoses or procedures to inflate charges
- Soliciting “kickbacks” for the provision of a range of services or goods
- Falsifying insurance claims
- Unlawful prescribing and dispensing of drugs
Our firm has successfully defended individuals and enterprises charged in health care fraud cases in federal district courts across the country. We have won dismissals, favorable plea agreements, and “not guilty” verdicts for our clients in federal criminal trials.
What Kinds of Health Care Fraud Charges are Possible?
There are numerous health care fraud offenses that can be brought in a federal court. Here are the most common ones, along with offenses that subject you to civil liability which can be combined with the federal crimes. Frequently, prosecutors pursue both avenues in their aggressive approach to combat health care fraud.
- 18 U.S.C. § 1347 Criminal Health Care Fraud
- 42 U.S.C. § 1320a-7b Anti-Kickback Statute
- 18 U.S.C. § 287 False Claims Act (Criminal)
- 31 U.S.C. § 3729 False Claims Act (Civil)
- Stark Law 42 U.S.C. § 1395nn, 42 CFR Subpart J Physician Self-Referral Law
- 18 U.S.C. § 1349 Health Care Fraud Conspiracy
- 18 U.S.C. § 1341, 18 U.S.C. § 1343 Wire and Mail Fraud
- 18 USC § 286 Conspiracy to Defraud the Government with Respect to Claims
- 42 U.S.C. § 1320a-7a Civil Monetary Penalties Law (CMPL)
Potential Penalties and Sentences for Health Care Fraud Convictions
The consequences for these crimes vary depending on which laws were violated. That said, you can face severe penalties if you get convicted on health care fraud, conspiracy, anti-kickback, false claims, or wire and mail fraud charges. Penalties include:
- Prison – Your sentence can be anything from 1 year to life in prison depending upon your conviction.
- Possible Monetary Fines – Criminal and civil fines can tally up quickly under health care statutes.
- Restitution – You could be mandated to refund payments received illegally through fraud or from self-referrals under the Stark Law.
- Revocation of Medical License or DEA Registration – Getting convicted on Health Care Fraud or Anti-Kickback charges can get your medical license or DEA registration revoked.
- Loss of Participation in Medicare/Medicaid Program – Convictions for Anti-Kickback Statute and Stark Law violations can end up in your debarment from participation in the federal Medicare and Medicaid programs.
- Asset Seizure and Criminal Forfeiture – Federal agencies may seize your assets while you are under investigation for health care fraud. These agencies include the DOJ, the FBI or the DEA. In fact, you could lose ownership of those assets under criminal forfeiture.
- National Practitioner Data Bank (NPDB)Â – Unlawful actions including convictions need to be reported in accordance with the Health Care Quality Improvement Act of 1983. This could impact your participation with other insurance plans.
Possible Defenses Against Health Care Fraud
- Lack of Intent or Error – To have committed fraud, you must have intended to cheat the government or insurer out of funds. If we can demonstrate that you acted in good faith but made an error, omitted information unintentionally, or billed improperly by mistake, you can avoid conviction of health care fraud.
- Lack of Evidence – The government prosecutor must present evidence of your intent to defraud. Their evidence must be sufficient in and of itself to prove intent beyond a reasonable doubt. Where there is a lack of sufficient evidence, conviction is impossible.
- Compliance Planning – A seasoned health care fraud lawyer can assist you in developing a thorough, proactive compliance plan to detect or deter fraudulent activity in your practice or business. Evidence of a comprehensive compliance plan can be used to show you lacked intent to engage in health care fraud.
- Consent – You have not committed fraud if you were given consent for your actions by the alleged victim. Evidence that you were granted permission to do the act that you are accused of is a solid defense against fraud charges.
- Safe Harbor Provisions in the Anti-Kickback Statute – There are a number of “safe harbor” provisions that may apply based on specific services and situations.
- Exceptions in the Stark Law – Stark Law Exceptions may permit physicians to make referrals in limited circumstances.
- Voluntary Disclosure – The federal agencies that enforce federal fraud and abuse legislation offer incentives to self-report violations. Incentives include reduction in payments owed. That said, there are risks with self-reporting and an experienced attorney can help you determine if that is an appropriate avenue for you.
- COVID-19 Waivers – The federal government recently implemented COVID-19 waivers which relax some health care fraud regulations. These might only be temporary, and an experienced health care fraud lawyer can help you to determine if a waiver applies in your situation.
Recent Developments and Current Trends in Health Care Fraud
- Tele-Health and COVID-19Â – Although COVID-19 ushered in the loosening of certain regulations to facilitate delivery of health care services such as telehealth, with release of trillions of dollars in funding under the CARES Act, the DOJ and OIG (Office of the Inspector General) will continue to closely monitor health care for possible criminal abuse. The OIG and the Department of Health and Human Services have also expressed concerns that fraud may be on the rise, particularly in relation to COVID-19 testing services.
- The Opioid Epidemic – While the opioid epidemic rages on, opioid use and prescriptions remains a top priority for the OIG. The OIG continues to keep a spotlight on pharmaceutical companies, physicians, private equity groups and pharmacy technicians to fight against fraud and over prescribing.
How Your Health Care Fraud Defense Attorney Can Assist You
Our law firm has successfully defended individuals and businesses facing charges of health care fraud in federal district courts across the United States. We have won dismissals, favorable plea agreements, and “not guilty” decisions for our clients in federal criminal trials. This is critical since a criminal conviction could prevent you from carrying on your medical practice.
Health care law is extremely complex. Your experienced health care fraud defense lawyer can help you navigate these serious charges. Our lawyers have the experience and resources necessary to defend even the most complex health care fraud cases. We nurture close relationships with former federal agents who we work with as investigators and forensic accountants. They help us to review the extensive medical billing records that are customarily a large part of successfully defending such cases. On top of that, we hire physicians and other medical experts to review the government’s allegations. They can show us where the prosecution’s case has weaknesses and help us mount a successful defense.
Get in Touch With Us Today
If you or your loved one has been charged with any form of heath care fraud in federal court, feel free to contact our health care fraud attorneys to discuss your case confidentially. We represent clients who are facing charges of Medicare fraud, Medicaid fraud and TRICARE fraud cases and many more in federal courts nationwide.