Fighting Charges of Fraudulent Healthcare Marketing Schemes

Fighting Charges of Fraudulent Healthcare Marketing Schemes

Getting accused of healthcare fraud can be scary. Even if you think you did everything by the book, the government may see things differently. So what can you do if you find yourself facing charges? This article talks about common fraudulent schemes, defenses that could help, and things to think about if you’re under investigation.

What Schemes Get Targeted?

Prosecuters tend to go after certain types of healthcare marketing they think trick or manipulate people. Some common schemes include:

Fake or misleading ads: Creating ads that lie or leave out important facts about a product or service. Things like promising miracle cures or not mentioning risks.

High-pressure sales: Using aggressive sales tactics to get people to buy things they don’t want or need. This could mean repeatedly calling people or not taking no for an answer.

Upcoding: Billing for more expensive services than were actually provided. Like billing for an hour-long doctor’s appointment when it was really just 15 minutes.

Kickbacks: Giving people money or gifts to get them to use your services. This could mean paying doctors to refer patients or giving people rewards for signing up.

So how do you fight back if you get accused? Here are some options to consider…

Lean on the First Amendment

One defense is arguing you were just exercising free speech. The First Amendment protects truthful commercial speech, meaning ads and marketing.

But there are exceptions. The government can restrict speech that’s illegal, deceptive, or promotes harm. So this defense hinges on showing your ads were truthful and legal.

Gather evidence like scripts and recordings proving you didn’t lie. Show satisfied customers who don’t feel tricked. Demonstrate you told the whole truth about risks and benefits. This can show the speech was lawful and not fraudulent.

Challenge the Claims as Overbroad

Another approach is arguing the fraud allegations are too broad or vague. Prosecuters might claim a whole scheme is fraudulent without specifics. But the law requires them to prove each fraudulent claim or act.

So file motions picking apart the charges piece by piece if needed. Require them to lay out specifics on every allegedly false claim or shady practice. This puts pressure on them to narrow and clarify the allegations. Then you can better respond to each one with facts or context showing lawful conduct.

Dispute Corrupt Intent

Most fraud laws require provining intent to mislead or deceive. This means showing the schemes were on purpose, not by accident or misunderstanding.

So evidence you acted in good faith can weaken their case. Things like policies and training materials urging ethical practices counter corrupt intent claims. You can also share expert opinions arguing the conduct was normal for the industry or circumstances.

The more you can show good intentions, the harder it is for them to prove you deliberately meant to mislead.

Cooperate and Settle?

If the evidence still looks bad, cooperating or settling may make sense. Settling saves time and money vs. a trial. And cooperating—like sharing info on higher-ups involved—might lead to lesser charges or immunity.

Just know settlements usually require admitting some fault or wrongdoing. So it depends on risks of losing at trial and how much an admission could hurt your business. Talk with your lawyer about the pros and cons.

Dealing with healthcare fraud charges is stressful no matter what. But focusing on strong defenses, and knowing all your options, can help get through it. With some luck—and lots of evidence on your side—you may just beat the allegations.