How Lawyers Protect Licenses and Reputations in Healthcare Fraud Cases

How Lawyers Protect Licenses and Reputations in Healthcare Fraud Cases

Healthcare fraud cases can be really tricky for lawyers. Mess up and you could lose your license or ruin your reputation. Here’s how the best lawyers protect themselves and their clients when dealing with healthcare fraud.

Know the Laws Backwards and Forwards

There are a ton of complicated laws around healthcare billing and reimbursements. Lawyers need to understand stuff like the Anti-Kickback Statute, the Stark Law, the False Claims Act, HIPAA, and state laws. It’s a maze of regulations. One little mistake could turn into a huge problem.

Good lawyers obsess over the details. They read up on stuff like safe harbor provisions that make some financial arrangements legal. They look for exceptions and loopholes. They keep up with new laws and court cases so they know how laws are being interpreted now.

Background Checks on Clients

Some clients try to get lawyers to help them commit fraud. Bad idea! Lawyers have to protect themselves by doing thorough background checks on potential clients. If a client seems shady, it’s better to turn down their business.

Lawyers also need to ask lots of questions up front and get documents to verify clients’ stories. That prevents surprises down the road. For instance, if a client says “Oh I forgot to mention I’m under investigation for Medicare fraud,” that’s a big red flag.

Careful Billing Review

Lawyers have to scrutinize clients’ billing records with a fine-toothed comb. They need to watch for double-billing, upcoding, phantom patients – anything fishy. Clients don’t always intend to commit fraud – sometimes it’s just sloppy billing practices.

But regardless of intent, bad billing can get both the client and lawyer in hot water. Lawyers have to identify problems and make clients fix them, even when it costs clients money. Better to lose some revenue than risk prosecution or disciplinary action.

Avoiding Conflicts of Interest

Lawyers can only advise one side in a dispute. So they have to check for conflicts of interest before taking on a new client. For example, they can’t represent a doctor accused of fraud if they previously worked for the insurance company suing her.

Conflict checks protect lawyers from ethics violations. But they also help avoid tricky situations where lawyers might accidentally use confidential information against a former client. Just staying away from conflicts keeps lawyers out of trouble.

Caution with Referral Fees

Some lawyers pay referral fees to other professionals who send them fraud cases. This isn’t necessarily illegal, but it can cross into kickback territory. Lawyers have to be very careful about how they structure these arrangements.

It’s safest to stick to flat fees based on the type of case, not the size of the settlement. And lawyers should wait until the case concludes before paying the referral fee. Otherwise, it can look like they’re exchanging payments for patient referrals.

Detailed Engagement Letters

Smart lawyers use very detailed engagement letters when taking on healthcare fraud cases. These letters spell out exactly what the lawyer will and won’t do. That prevents misunderstandings down the road.

For instance, the engagement letter may specify that the lawyer won’t backdate documents or lie to investigators. Some desperate clients will ask lawyers to cross ethical lines. The engagement letter makes it clear those things won’t happen.

Careful Communication

Lawyers have to be super cautious about what they put in writing on healthcare fraud cases. Prosecutors will scour emails and memos for any suggestion the lawyer knew about or covered up fraud.

Casual comments like “Don’t worry, I’ll take care of the billing issues” can look bad out of context. Lawyers need to communicate verbally as much as possible and choose written words carefully.

Know When to Walk Away

If a client won’t listen to their advice or is clearly committing fraud, smart lawyers will drop them immediately. The client may threaten to sue for malpractice, but it’s better than being associated with illegal schemes.

Lawyers who suspect fraud have to stop work right away and terminate the relationship. Continuing to represent the client can make the lawyer liable too. Protecting their license and reputation means walking away quickly.

Get Malpractice Insurance

Malpractice insurance is a must for any lawyer doing healthcare fraud defense work. Even careful lawyers can end up involved in disciplinary or criminal proceedings through no fault of their own.

Insurance gives financial protection in case lawyers have to defend themselves before the bar association or in court. Without coverage, a complaint could bankrupt some lawyers – even if it’s eventually dismissed.

Refresher Ethics Training

Healthcare fraud issues get very complex ethically. Laws impose duties on lawyers to prevent and report fraud in some cases. Those duties can conflict with attorney-client confidentiality rules.

Frequent ethics training helps lawyers navigate these tricky situations. They learn how to avoid assisting crimes while still protecting clients’ rights. Ethics courses also remind lawyers to prioritize their duties over clients’ demands.

Build a Strong Reputation

The best protection for lawyers is a strong professional reputation. Other lawyers and judges won’t suspect ethical lawyers of complicity in fraud. They’ll give the benefit of the doubt if questions arise.

Reputations take years to build through honest, competent work. But it’s worth it for the trust and respect it creates. Clients also appreciate working with respected lawyers, so it generates referrals.

Assistance from Experienced Counsel

If regulators or prosecutors come knocking about potential fraud, lawyers shouldn’t try to handle it alone. The smartest thing is to get experienced outside counsel to advise them.

An outside attorney can objectively assess the situation and defend the lawyer’s interests. They know all the right moves to counter allegations and protect reputations. It’s worth the cost to have an expert guide you through the process.

Having outside counsel also shows regulators the lawyer is taking the situation seriously. They aren’t trying to hide anything. Cooperation and transparency help resolve investigations faster with fewer penalties.

Stay Calm Under Pressure

Healthcare fraud investigations can be stressful for lawyers, who may fear for their livelihoods and reputations. It’s essential to stay calm and think clearly under pressure.

Making rash moves like destroying documents or lying to investigators only makes things worse. Lawyers need to get advice from experienced counsel, then respond thoughtfully and strategically.

Panicking causes mistakes. By staying calm, lawyers can get through the investigation and protect their licenses. A few deep breaths go a long way in a crisis.

Negotiate Settlements Carefully

Healthcare fraud cases often end in settlements to avoid long trials. Lawyers are often the ones negotiating these deals for their clients.

They need to be very careful not to cross any lines themselves during settlement talks. Any agreements should focus on the client’s liability, not the lawyer’s actions.

And settlements shouldn’t try to improperly bury evidence of fraud. Lawyers must avoid even the appearance of concealing illegal activity.

Self-Report Minor Violations

Mistakes happen, even when lawyers are trying to do everything right. If lawyers catch their own minor ethical lapses, it’s best to self-report to the bar association.

Self-reporting shows regulators the violation was inadvertent and the lawyer is willing to take responsibility. The penalties are usually just additional ethics training or monitoring.

But failure to disclose makes the mistake far more serious when regulators eventually find out. Self-reporting is uncomfortable but smart.

Conclusion

Navigating healthcare fraud issues takes knowledge, caution and plenty of ethical radar. But lawyers can protect their licenses and reputations by keeping clients on the straight and narrow.

It’s not easy, but an ounce of prevention is truly worth a pound of cure when it comes to healthcare fraud defense work. Stopping problems before they start keeps lawyers out of trouble.