How Lawyers Defend Telemedicine Healthcare Fraud Charges

How Lawyers Defend Telemedicine Healthcare Fraud Charges

Telemedicine has exploded in popularity over the past few years. With telemedicine, patients can conveniently access healthcare services remotely using phone or video conferencing technology. This allows patients, especially those in rural areas, to obtain medical care without traveling long distances to see a doctor in person.

However, the rapid growth of telemedicine has also led to an increase in healthcare fraud allegations. Telemedicine companies have been accused of billing for services not rendered, paying kickbacks for patient referrals, and prescribing unnecessary or excessive medications. When fraud charges are brought, telemedicine companies often hire skilled lawyers to defend themselves. So how exactly do lawyers defend their telemedicine clients against fraud allegations?

Challenging the Legal Basis of Fraud Charges

The first line of defense for telemedicine lawyers is to challenge whether the fraud charges have merit in the first place. Healthcare fraud cases are usually brought under laws such as the federal False Claims Act, Anti-Kickback Statute, and Stark Law. Lawyers will scrutinize the specific allegations to see if they actually violate these laws as written. For example, the Anti-Kickback Statute prohibits payments made to generate patient referrals for services paid by Medicare/Medicaid. But there are safe harbor exemptions for certain payments. If a telemedicine company’s payment practice falls under a safe harbor, their lawyer can argue it does not violate the Anti-Kickback Statute.

Attacking the Evidence of Fraud

In any fraud case, the evidence presented is crucial. Prosecutors typically rely on documentation like medical records, billing records, patient testimony, etc. to prove their case. Defense lawyers will meticulously examine this evidence to identify any weaknesses. For instance, if a key medical record appears altered or a patient’s testimony seems unreliable, this casts doubt on the prosecution’s fraud claims. Lawyers can file motions to exclude evidence from trial if it is hearsay, irrelevant, improperly obtained, etc. Weakening the available evidence makes it much harder to prove healthcare fraud occurred.

Arguing Lack of Intent

Most healthcare fraud laws require prosecutors to prove the defendant acted with intent or “knowingly and willfully” committed fraud. As a result, defense lawyers will argue their telemedicine clients simply made mistakes or errors but did not intentionally commit fraud. This is easier when the fraud allegations are against a corporation rather than specific employees. Corporations can claim rogue employees acted alone without management’s knowledge. But even individual defendants can assert they did not fully understand complex coding/billing rules and made billing errors in good faith. Without clear evidence of intent, charges may be dismissed.

Pursuing Procedural Issues

Telemedicine lawyers also look for procedural problems with how the government conducted the fraud investigation or filed charges. They may allege health inspectors exceeded their authority, prosecutors failed to follow appropriate protocols, evidence was improperly collected, etc. For instance, in one recent case, charges were dismissed because prosecutors infringed on attorney-client privilege. Convincing a judge that procedural mistakes compromised the defendants’ rights can get charges thrown out.

Negotiating Settlements

Many healthcare fraud cases end in a settlement rather than going to trial. Settlements allow defendants to avoid harsh penalties and the uncertainty of a trial. Government prosecutors also have incentives to settle because trials are time-consuming. Lawyers will negotiate aggressively to get charges dropped or reduced, civil fines minimized, and corporate integrity agreements tailored to their clients’ business. A favorable settlement can enable a telemedicine company to move past the fraud allegations with minimal long-term damage.

Avoiding Recurrence Through Compliance

Lastly, for telemedicine clients facing fraud charges, their lawyers have a key role in advising them on compliance going forward. This ensures the company implements proper protocols, training, auditing, etc. to prevent recurrence of any problematic activities. Robust compliance helps demonstrate the allegations were an aberration rather than endemic fraud. It also reduces the likelihood of future government scrutiny.

Defending complex healthcare fraud cases requires in-depth knowledge of medical billing rules, experience dealing with federal prosecutors, and meticulous evaluation of evidence. But telemedicine lawyers have a variety of strategies to protect their clients’ interests. With persistent advocacy and procedural savvy, skilled attorneys can frequently minimize penalties or even get charges dismissed altogether. This allows telemedicine companies to move past fraud allegations and continue providing their vital healthcare services.

References

Anti-Kickback Statute Safe Harbor Regulations
Telemedicine Investigation Case Study