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How Lawyers Build a Defense Strategy for Healthcare Fraud Cases

March 21, 2024 Uncategorized

How Lawyers Build a Defense Strategy for Healthcare Fraud Cases

When a healthcare provider or organization gets accused of fraud, it can be a scary situation. The government don’t play around when it comes to healthcare fraud – we’re talking big fines, even jail time. So if you find yourself facing a healthcare fraud investigation or charge, the first thing you need is a good lawyer on your side. In this article, we’ll walk through how lawyers build a defense in these complex cases.

Understanding the Allegations

The first thing your lawyer will do is get a handle on what exactly you’re being accused of. Healthcare fraud covers a wide range of activities – from billing for services that were never provided, to paying kickbacks for patient referrals, to falsifying diagnoses to justify unnecessary procedures. The allegations against you will determine the specifics of your defense strategy. Your lawyer will review the complaint thoroughly and identify the key claims being made. This gives them a roadmap of what issues need to be addressed.

Gathering the Facts

Next, your legal team will start gathering all the facts. They’ll review billing records, patient files, and other documentation to understand what was actually going on. This evidence will help prove whether the allegations have merit or not. Your lawyer will also interview you and other employees to get testimonies on the situation. The goal is to separate truth from fiction – were false claims actually submitted, or is the government wrong in their accusations? Detailed documentation and testimony are crucial to build a strong defense.

Evaluating the Merits of the Case

Once the facts are gathered, your lawyer will determine if the government’s case has legal merit. They’ll analyze whether the specific allegations, if true, would actually constitute fraud under the law. For instance, maybe you billed for services that weren’t “medically necessary,” but you had a reasonable basis for providing them. Or perhaps the coding on your claims was incorrect, but there’s no evidence it was done intentionally. Looking at the nuances helps determine any weaknesses in the prosecution’s argument.

Developing Affirmative Defenses

A key part of the defense strategy is developing affirmative defenses – reasons why you should not be held liable even if some of the allegations are true. Common defenses in fraud cases include:

  • Lack of intent – This argues you did not knowingly or intentionally commit fraud.
  • Good faith – You had a sincere belief that your conduct was lawful and proper.
  • Compliance program – You had policies and procedures reasonably designed to prevent wrongdoing.

Your lawyer will look for facts to justify these defenses. For instance, proving you relied on guidance from Medicare representatives when billing questionable services. Or showing you had compliance training for employees. Affirmative defenses cast doubt on your liability.

Attacking the Evidence

In addition to affirmative defenses, your legal team will scrutinize the government’s evidence for any weaknesses. Are the allegations backed up by solid documentation, or based on conjecture? Does the evidence definitively prove intent and knowledge of wrongdoing? Are there credibility issues with the government’s witnesses? Cracks in the evidence can undermine the prosecution’s case.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

Negotiating a Settlement

Often healthcare fraud cases end in a settlement rather than trial. Your lawyer will negotiate with the prosecution for a favorable resolution. This may involve admitting limited wrongdoing in exchange for reduced penalties or avoiding criminal charges. Settlements avoid the risk and expense of a trial. Much depends on the strength of the defense case versus the prosecution’s evidence. Your lawyer will craft a deal that minimizes damage.

Preparing for Trial

If a reasonable settlement can’t be reached, the case may go to trial. Your lawyer will continue building defenses and evidence for trial. They’ll file motions asking the judge to dismiss the case or exclude certain evidence. Developing a trial strategy is complex – who will be called as witnesses, what testimony to challenge, what order to present evidence. Thorough preparation is key, since healthcare fraud trials can involve millions in fines.

Navigating Sentencing

If found guilty at trial, your lawyer’s focus will shift to minimizing sentencing impact. They’ll present mitigating factors like your prior record, compliance program, and cooperation with authorities. For financial penalties, they’ll compile evidence of inability to pay. And they’ll emphasize how prohibitions from Medicare participation already deliver punishment. Vigorous advocacy at sentencing can reduce fines and jail time.

Facing healthcare fraud charges is daunting. But an experienced legal team can build a strong defense to achieve the best possible outcome. With attention to the details and a compelling narrative, even complex fraud cases can be overcome. Don’t go it alone – get a lawyer fighting on your side.

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Todd Spodek

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RALPH P. FRANCHO, JR

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JEREMY FEIGENBAUM

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ELIZABETH GARVEY

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CLAIRE BANKS

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RAJESH BARUA

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CHAD LEWIN

Of-Counsel

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