How Lawyers Defend Cases of Fraudulent Healthcare Credentialing

How Lawyers Defend Cases of Fraudulent Healthcare Credentialing

Getting accused of fake credentials to get healthcare work sucks. It can end your career. Lead to big fines or even jail time. But it don’t have to be a death sentence. Defense lawyers have lots of tricks to fight back against these charges. This article will go over how they do it.

What is Credential Fraud in Healthcare?

First, what exactly is credential fraud? It’s when someone lies about being licensed, certified or having the right education to get healthcare jobs. For example:

• Claiming to have a nursing degree when you didn’t graduate or go to nursing school
• Saying your a doctor but never went to med school or residency
• Faking credentials like board certification or specialty training
• Using someone else’s license number or DEA registration

Healthcare employers do background checks. But some folks still slip through with phony credentials. And get caught later when red flags pop up.

Why Do People Do It?

There’s a few reasons healthcare workers sometimes fake credentials:

• Better job opportunities and higher pay
• Ego – feeling important saying your a “doctor”
• Hide a gap in employment
• Lack skills/training for the role

It’s wrong and illegal. But it happens more than you think. Desperate folks make bad choices. And get in big trouble later on.

The Charges They Face

If caught, you’ll likely face charges like:

• Healthcare fraud – can be a felony charge
• Identity theft
• Forgery
• Practicing without a license
• Insurance fraud
• Medical malpractice

You may also get sued by patients that got hurt. So it’s a legal mess. But defense lawyers have some good strategies to fight back.

Question the Screening Process

The first thing the lawyer will do is investigate the hiring and screening process. They look for weaknesses like:

• Rushing to fill jobs without thorough background checks
• Allowing candidates to self-report licenses and education
• Not verifying credentials directly with issuing organizations
• Failing to fingerprint applicants and run criminal checks

If the employer was sloppy, it weakens their case. The lawyer argues they should’ve caught the fraud earlier with proper diligence.

Blame it on Bad Paperwork

One defense is claiming it was just a paperwork mixup. For example:

• “The application asked about ‘certifications’ and my client thought that meant CPR training.”
• “They misunderstood the question about professional licenses.”
• “Previous employers must have reported incorrect info about credentials.”

While mistakes don’t justify lies, it casts doubt on intent to deceive. And intent is key.

Question How Material the Lies Were

The defense will argue the phony credentials weren’t material – meaning they didn’t actually influence the hiring decision. For example:

• “The client was clearly qualified despite the exaggerated credentials.”
• “Here are other applicants hired without the credentials.”
• “It was just HR negligence and not fraud that led to the hiring.”

If the lies weren’t material, it weakens the case. The lawyer fights to get charges dismissed on this basis.

Allege Sloppy Supervision

Another tactic is claiming supervisors didn’t properly monitor the employee and patients got harmed as a result. This shifts blame back to the employer.

The lawyer argues the company has duty to supervise staff. So negligent supervision led to any fraud or malpractice.

Try Cutting a Deal

Many fraud cases end in plea bargains. This involves pleading guilty to lesser charges to avoid a trial. The lawyer tries negotiating with prosecutors for a good deal.

It’s risky but provides certainty. The lawyer advises on whether to accept a deal or take changes at trial.

Point Out Lack of Actual Harm

A big defense strategy is arguing no patients got hurt. The lawyer looks closely at outcomes data trying to prove this.

If the client did their job well despite fake credentials, it really weakens the case. It’s a big mitigating factor at sentencing too.

Blame Desperate Circumstances

Juries sympathize with desperate circumstances. So the defense highlights things like:

• Client was just trying to feed a family
• They couldn’t get hired without lying
• Personal problems or addiction issues
• Accept responsibility and remorse

It’s not a legal defense but it aims for leniency in punishment.

Question Expert Witnesses

Prosecutors use expert witnesses to prove standards were violated. But the defense pokes holes in them with things like:

• Questioning if they are even qualified to judge this area
• Pointing out lack of direct experience in the field
• Arguing the standard of care is subjective

Undermining the expert witness testimony weakens the case.

Highlight Quality of Care Given

At trial, the defense presents evidence of quality care provided to patients. Testimony from satisfied patients helps create doubt.

Even with phony credentials, if the care was proper it suggests minimal harm.

Have Client Testify and Show Remorse

It’s risky but the lawyer may advise the client to testify to show remorse and take responsibility. This aims for jury sympathy and lighter punishment.

Thorough prep is key so they don’t get trapped during cross-examination.

Summary of Defense Strategies

Here’s a quick summary of tactics lawyers use to defend credential fraud charges:

• Question flaws in the hiring process
• Claim it was just paperwork mixups
• Argue lies weren’t material to hiring
• Allege negligent supervision
• Try for a plea bargain
• Point to lack of patient harm
• Highlight desperate circumstances
• Undermine expert witnesses
• Show quality care was provided
• Have client testify to show remorse

Fighting healthcare credential fraud charges is an uphill battle. But an experienced lawyer can often get charges reduced or avoid jail time in many cases.