Healthcare fraud is a serious federal crime that has substantial penalties. Both individuals and corporations can be prosecuted in healthcare fraud cases. Because the realm of healthcare fraud is expansive, it is important to understand what constitutes healthcare fraud and how a healthcare fraud attorney may successfully defend you against the charges you face. Because of the unique nuances of these cases, the expertise of a criminal defense attorney who specializes in healthcare fraud is essential.
Understanding Healthcare Fraud
A healthcare fraud crime occurs when an individual or an entity attempts to defraud a healthcare benefits program or when a fraud plan is successfully executed. To be classified as healthcare fraud, the individual or entity must engage in the plan knowingly and willfully. The umbrella of healthcare fraud crimes is expansive, and the crimes may target health insurance companies, Medicaid, Medicare and others. Those who engage in the fraud may include medical billing services, physicians’ offices, hospitals, patients and more.
Some of the many examples of healthcare fraud include falsifying dates of service, waiving co-payments and deductibles, misrepresenting the need for services, buying back prescription drugs, reporting services or procedures incorrectly, billing for drugs or services that were not actually provided to the patients and more. Keep in mind that healthcare fraud can be prosecuted as a federal crime, and it may be pursued in civil courts as well.
Healthcare Fraud Penalties
In many cases, a defendant is aware of the investigation well before charges are filed. Your experienced criminal defense attorney should be involved in the case as soon as you learn of the healthcare fraud investigation. This is because the attorney will work to ensure that your rights are protected during searches, through questioning and more. While many cases may be settled through a plea bargain, others are tried in court. Defendants who are convicted of violating the False Claims Act could be responsible for up to $250,000 in fines and up to life in prison. Be aware, however, that the dollar amount of the alleged fraud will directly impact the fines that are imposed in a specific case.
In addition to the punishments, there are other consequences of a plea bargain or a guilty verdict. In such cases, accused physicians and medical offices may be required to close their practice. This level of impact may apply to other types of defendants as well in different ways because of the severity of the charges. Some additional consequences that may impact some defendants are Medicare exclusion, the loss of a DEA registration, the loss of a state license, staff credentialing actions, denial of insurance billing privileges and more.
Healthcare Fraud Defense Strategies
Defense strategies for healthcare fraud begin well before the trial stage. For example, an attorney may attempt to prove that select communications are privileged and should not be taken into account in discovery. A claim of conspiracy or lack of intent may be used at this stage when electronic communications are reviewed.
During the trial, a criminal defense attorney may utilize one or several major defense strategies. These include challenging how statistical data is analyzed, challenging testimonies, selecting the jurors strategically, using various medical experts, citing contradictory information in various standards of care and guidelines, using character witnesses and more.
In some instances, defense attorneys representing different individuals will pool their resources to present a strategic, comprehensive defense. There is not a single defense strategy that works well in all cases. Instead, the attorneys must come together to collectively build the strongest defense possible to target each specific area of the prosecution’s case.
Request a Legal Consultation Today
A conviction of healthcare fraud has extensive consequences regardless of the nature of the charges. These cases are often complex and require expertise in detailed matters and of the complicated healthcare system as a whole. With these factors in mind, professional representation from a seasoned criminal defense attorney with specific experience in healthcare fraud is essential. If you have recently become aware of a developing investigation against you or if charges have already been brought against you, your next step should be to hire a healthcare fraud defense attorney. To request a detailed consultation, email or call the office today.
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