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What to Do if You’re Charged with Healthcare Fraud Involving Opioids
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What to Do if You’re Charged with Healthcare Fraud Involving Opioids
So you got charged with healthcare fraud involvin opioids. That sucks. I know your probably freaking out right now. Take a breath. It’s going to be OK. This article will walk you through what to expect and give you some tips on how to handle the situation.
The Charges
The first thing you need to do is understand exactly what your being charged with. Healthcare fraud is a big category that covers a lot of things. Here are some of the specific charges you might see:
- Prescription fraud – This means writing fake prescriptions to get drugs illegally. Or altering real prescriptions to get more drugs.
- Insurance fraud – Billing insurance companies for services that weren’t provided. Billing for more expensive services than were actually done.
- Kickbacks – Getting paid to refer patients for healthcare services. This is illegal if you don’t disclose it.
- Identity theft – Using someone else’s identity to bill services.
- Falsifying records – Changing medical records to cover up fraud.
The charges will list specific laws you violated from the federal criminal code. Look up the codes so you understand exactly what your being accused of. This will help you figure out your defense.
Get a Lawyer
The most important thing to do is get a lawyer immediately. Don’t try to handle this yourself. Healthcare fraud charges are serious felonies that can land you in prison for years. You need an experienced criminal defense attorney to fight the charges.
Many lawyers offer free consultations. Call around and find one who specializes in healthcare fraud cases. Ask about their experience and success record. Make sure their someone you feel comfortable with. This case could drag out for awhile, so you want a lawyer your able to work with.
Don’t worry if you can’t afford a private attorney. The court will appoint a public defender for you if your income is low enough. Public defenders are real lawyers who went to law school just like other attorneys. Their not as bad as TV makes them seem.
Understand the Process
Once you have a lawyer, they’ll explain the legal process and what to expect. Here’s a quick overview:
- Arrest – If you haven’t been arrested yet, you may be soon. The police will come to your home or work and take you into custody. You’ll be photographed, fingerprinted, and held until bail is set.
- Don’t resist arrest – that will just cause more legal problems. But don’t say anything either except to ask for your lawyer.
- Charging document – This is the formal accusation against you. It will lay out the specific charges and the facts alleging you committed those crimes. The document might be called an indictment, information, or complaint depending on how the charges were brought.
- Arraignment – Your first court appearance. You’ll be formally notified of the charges against you and asked to enter a plea of guilty, not guilty or no contest. Nearly always plead not guilty at this stage.
- Pretrial motions – Your lawyer will file motions challenging the prosecution’s case and evidence. This can result in charges being dismissed or reduced before trial.
- Plea bargaining – Negotiating with the prosecution to plead guilty to lesser charges in exchange for dropping more serious ones. This avoids the risk of trial.
- Trial – If no plea bargain, the case will go to trial before a judge or jury. The prosecution must prove guilt beyond a reasonable doubt. You can be convicted, acquitted or get a hung jury.
- Sentencing – If found guilty, the judge will impose a sentence based on guidelines and the facts of the case. You’ll likely face prison time and massive fines.
This whole process can take over a year. It’s a marathon, not a sprint. Listen to your lawyers advice every step and you’ll get through it.
Build Your Defense
Your lawyer will handle the legal defense. But they need your help building the factual defense. Gather up any evidence or records that support your side of the story:
- Medical records – Showing you provided legitimate services and treatment.
- Billing records – Proving claims were properly coded and submitted.
- Emails/documents – Anything refuting the prosecution’s accusations.
- Witnesses – Coworkers or patients who can testify on your behalf.
Also write down a detailed timeline of your version of events. Your lawyer can compare it to the prosecution’s timeline to find inconsistencies and holes to exploit.
Basically reconstruct anything showing your innocence. Your lawyer can use it to get charges dismissed before trial. Or to raise reasonable doubt during trial.
Also think about your character witnesses. Friends, colleagues, community members who will testify to your honesty and integrity. This gives the jury a counter-narrative to the prosecution’s attacks.
Consider Taking a Plea Deal
Once you see the evidence against you, your lawyer may recommend taking a plea bargain rather than risk trial. I know you probably want to fight the charges. But hear them out.
Plea deals let you plead guilty to lesser charges in exchange for dropping the most serious ones. You’ll still have penalties but not as severe. And you avoid the possibility of a maximum sentence if you lose at trial.
Over 90% of criminal cases end in plea bargains. They give certain outcomes versus the uncertainty of trial. Talk it over fully with your lawyer before deciding.
If Convicted, Get Ready for Sentencing
I hope it doesn’t come to this. But if your convicted at trial, get ready for sentencing. The penalties can be severe:
- Prison time – Healthcare fraud involving opioids can mean 5, 10, 20 years or more in federal prison. The more victims and money lost, the longer the sentence.
- Fines – You’ll also get slapped with massive criminal fines – possibly millions of dollars. Don’t expect to pay these off anytime soon.
- Restitution – The court may order you to repay victims for their losses from your crimes. It’s rare to fully repay this.
- License revocation – If your a healthcare provider, your medical license will likely be revoked. This kills your career.
- Forfeiture – Any property connected with the crimes – homes, cars, bank accounts – can be seized. You’ll never see these assets again.
It’s devastating, especially for first-time offenders. Have your lawyer highlight any mitigating factors to reduce the penalties. And get family support – you’ll need it.
What About the Opioid Crisis?
The opioid epidemic makes these cases high priority for prosecutors. Hundreds of thousands have died from opioid overdoses. Prosecutors want to crack down on doctors and pharma companies viewed as enabling addiction.
But each case is unique. Don’t let the climate of outrage affect your judgment. Fight charges that aren’t justified. Take plea deals that are reasonable. Use discretion and listen to your lawyers guidance.
Despite the backlash, even healthcare fraud cases related to opioids get fair treatment under the law. Work within the system and you can get through this. It will be a difficult road, but stay positive.
Conclusion
Dealing with healthcare fraud charges is scary. But now you know a bit of what to expect. Get an experienced lawyer, understand the process, build your defense and carefully weigh your options along the way. Despite how it feels, this doesn’t have to ruin your life. Stay calm and take it one step at a time. Millions have been in your shoes and came out OK in the end.
Here are some useful resources on healthcare fraud charges and criminal law: