16 May 23

Healthcare defense: Understanding healthcare fraud lawyers

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Last Updated on: 3rd June 2023, 09:25 pm

The Alarming Increase of Healthcare Fraud in the United States

Astoundingly, healthcare fraud has exponentially surged, posing a sizable threat to the United States’ well-being. The Federal government is deeply worried as the rising number of reported cases suggests that fraudulent claims comprise a staggering 3 percent of the total healthcare budget. This results in astronomical losses year after year. Consequently, the government now aggressively battles against healthcare fraud all across the country.

The Department of Health and Human Services, local attorney generals, and the Office of Inspector General have teamed up to guarantee that individuals found guilty of healthcare fraud face the full force of the law. With their backs against the wall, investigators involved in healthcare fraud cases must rely on previous employees, confidential informants, and anyone else capable of providing damning evidence.

Over the past few years, federal funding for healthcare has experienced a significant boost across states, leading to a surging increase in auditing for healthcare fraud. This heightened scrutiny has placed innumerable healthcare professionals on the hook for potential fraudulent activities. Caught in the whirlwind of allegations, it is essential for anyone under investigation or facing charges related to health care fraud to promptly contact an experienced lawyer with expertise in this area.

Common Examples of Healthcare Fraud:

Many medical practitioners inadvertently find themselves in hot water, simply because they are unaware of what truly constitutes healthcare fraud. Others are ensnared due to negligence or honest administrative errors. Some prevalent examples include:

  • Deceitfully submitting false claims with insurance companies with the intention of receiving money
  • Accepting illicit kickbacks and referral fees
  • Charging non-existent patients
  • Billing for services not provided
  • Up-coding
  • Dishonestly presenting misleading information about services rendered
  • Providing false information when applying for Medicare/Medicaid programs
  • Billing for equipment never supplied
  • Employing excluded providers

Healthcare Fraud Charges and Defense Strategies:

The Federal Bureau of Investigation (FBI), Drug Enforcement Authority (DEA), and Office of Inspector General meticulously investigate these cases before turning them over to the United States Attorney from the Department of Justice for prosecution. It typically falls under one of three significant acts:

Act Description
Fraud 18 U.S.C 1347 This act focuses on pharmacists, physicians, and other healthcare practitioners suspected of issuing improper prescriptions or dispensing incorrect medication to patients. Investigators also attempt to determine if prescription medicine and medical supplies qualify for Medicare and other federal government program reimbursements.
Medical Anti-kickback Statute This statute deems it illegal for any healthcare practitioner or provider to offer payment or remuneration, whether directly or indirectly, in kind or cash, to anybody to obtain patient referrals within the healthcare program.
False Claims Act Arguably the most potent weapon used by the federal government against healthcare fraud, the False Claims Act imposes both criminal and civil liabilities upon anyone submitting fraudulent claims for reimbursement in federal healthcare programs. False claims encompass billing errors, coding errors, certifications, and any other mistakes healthcare providers make relating to payment claims. The regulations governing federal reimbursements are highly intricate; violating them can lead to a maelstrom of additional criminal charges, including forgery, conspiracy, false statements, and money laundering.

The Harsh Reality of Penalties and Punishment for Healthcare Fraud

Those found guilty of healthcare fraud receive severe punishments, such as professional disciplinary actions, loss of operating licenses, exclusion from state/federal health programs like Medicaid/Medicare, lengthy jail terms, and crippling monetary fines.

Healthcare Fraud Defense

What might appear as simple administrative errors can ultimately crescendo into formal criminal charges in a court of law. In instances where investigations proceed after receiving a letter or phone call from prosecutors, the essential first step becomes contacting an experienced lawyer who specializes in this field. This legal professional will guide you through your defense process, helping to protect your rights and livelihood.

Healthcare defense: Understanding healthcare fraud lawyers

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