What to Do if You’re Charged with Healthcare Fraud Involving Medical Records Companies

What to Do if You’re Charged with Healthcare Fraud Involving Medical Records Companies

Being charged with healthcare fraud can be an incredibly scary and overwhelming experience. You may feel anxious, confused, and unsure of what to do next. This article provides practical guidance on navigating the legal process if you or your medical records company are accused of healthcare fraud.

Don’t Panic – Seek Legal Counsel Immediately

The first thing you should do is contact an experienced healthcare fraud defense attorney. An attorney can advise you on your rights and options, develop the strongest possible defense, and represent you through the legal process. Look for lawyers with specific experience in healthcare fraud cases and medical records regulations. Vet several qualified attorneys before choosing one you trust.

It’s critical to have legal representation in place before speaking to investigators or prosecutors. Anything you say can be used against you. With an attorney present, you are better protected.

Understand the Charges Against You

Make sure you understand exactly what you or your company are being charged with. Healthcare fraud is a broad term that encompasses:

• Billing for services that were never performed
• Billing for unnecessary tests or procedures
• Upcoding services for higher reimbursement
• Falsifying diagnoses to justify tests or procedures
• Accepting kickbacks for patient referrals
• Misrepresenting non-covered treatments as medically necessary
• Deliberately submitting incorrect cost reports

Medical records companies and personnel may be accused of aiding in healthcare fraud by altering, destroying, or fabricating patient records and documents. Make sure you understand the specific charges so you can start building your defense.

Know the Consequences – Healthcare Fraud is Serious

Being convicted of healthcare fraud carries severe penalties. For each charge, you may face:

• Up to 10 years in prison
• Fines up to $250,000 for individuals or $500,000 for companies
• Restitution payments to compensate victims
• Exclusion from participating in Medicare/Medicaid

These substantial penalties make building a strong legal defense critical.

Build Your Legal Defense Strategy

Your attorney will determine the right defense based on the specifics of your case. Common strategies in medical records fraud charges include:

• No intentional misconduct – Argue any billing or documentation errors were mistakes, not deliberate illegal actions.
• Lack of knowledge – Claim you were unaware of any wrongdoing within your company.
• Blame a “bad apple” employee – Allege an individual employee acted improperly without your knowledge.
• Justify the medical necessity – Explain why tests, treatments, or other services were medically needed despite lack of documentation.

Your lawyer may also challenge improper government procedures, missing evidence, or unreliable witnesses. Reference key healthcare fraud laws and legal precedents to build the strongest case.

The Legal Process: What to Expect

If formally charged, you will face a complex legal process including:

1. Arraignment – You appear in court and enter a plea of guilty, not guilty, or no contest.
2. Pretrial motions – Your lawyer may file motions contesting evidence, requesting documents, etc.
3. Pretrial conferences – The judge, prosecutors, and defense counsel meet to discuss plans, evidence, plea deals, etc.
4. Trial – Both sides present evidence and arguments before a judge or jury who determines guilt or innocence.
5. Sentencing – If found guilty, the judge determines penalties based on sentencing guidelines and other factors.
6. Appeals – You can appeal the verdict or sentence and request a new trial.

This complex process makes experienced legal counsel essential. Your attorney will represent your best interests at every stage.

Consider a Plea Deal or Settlement

Many healthcare fraud cases end in plea bargains or settlements to avoid trial. In a plea bargain, you plead guilty in exchange for lesser charges or a lighter sentence. Settlements involve paying fines and penalties without admitting guilt. Your lawyer will advise if a plea or settlement makes sense for your situation.

Cooperate Fully and Honestly with Investigators

Cooperating with the investigation can potentially help your case. Actions like destroying evidence or lying to prosecutors may lead to additional charges. Be open and honest when investigators question you and provide requested documents fully and promptly. Your attorney will ensure you do this correctly.

If Convicted, Request Leniency in Sentencing

If found guilty at trial, your attorney can request leniency in sentencing based on factors like:

• Lack of criminal history
• Commitment to rehabilitation
• Family obligations
• Charitable works
• Remorse and acceptance of responsibility

The judge has discretion to assign penalties below sentencing guidelines. Your lawyer will present the strongest case for minimized punishment.

Explore Options for Suspended Sentences

In some cases, you may qualify for a suspended sentence where you avoid jail time unless you violate release conditions. Common requirements are:

• Probation – Regular check-ins with a probation officer
• Fines – Financial penalties must be paid
• Community service – Court-ordered volunteer work
• Rehabilitation – Completing counseling or treatment programs

Violating release terms leads to the original sentence being imposed. Your attorney can advise if a suspended sentence is possible.

Appeal the Verdict or Sentence

If convicted, you can appeal based on issues like procedural errors, insufficient evidence, ineffective counsel, and excessive sentences. The appeals court may overturn the verdict, order a new trial, or reduce the sentence. According to one analysis, about 20% of healthcare fraud convictions are overturned on appeal so this option is worth exploring.

Avoid Actions That Worsen Your Case

It’s critical to avoid certain actions when facing charges, including:

• Destroying or hiding evidence
• Attempting to influence witness testimony
• Retaliating against whistleblowers
• Obstructing the investigation
• Fleeing the jurisdiction

Such actions may constitute additional crimes. Be cooperative and let your legal counsel handle communications.

Take Responsibility and Learn from the Experience

If convicted, avoid blaming others or making excuses. Judges may look more favorably on individuals who take responsibility for their actions. Use the experience to implement stronger compliance programs that proactively prevent fraud.

Consult Experienced Healthcare Fraud Defense Attorneys

Facing healthcare fraud charges related to medical records can be daunting. The potential penalties are severe. Work with qualified legal counsel to build your defense, navigate the system, and achieve the best possible outcome. With persistence and a well-executed strategy, you can move forward in the most constructive manner.