Criminal Defense Lawyers

NYC Healthcare Fraud Criminal Lawyers

Healthcare fraud is a serious federal offense that can have severe consequences. So, what do you do, if you get hit with one of these things? 1

Understanding Healthcare Fraud

Healthcare fraud involves knowingly and willfully executing, or attempting to execute, a scheme to defraud any healthcare benefit program. It can include submitting false claims, misrepresenting services, or making illegal kickback arrangements. Even if you didn’t intend to defraud, lack of knowledge is not a valid legal defense. 1Common examples of healthcare fraud include:

• Billing for services not rendered
• Upcoding to receive higher reimbursements
• Performing unnecessary services solely for insurance billing
• Falsifying patient records or treatment plans
• Accepting kickbacks for patient referrals

Consequences of Healthcare Fraud

Healthcare fraud is a federal crime investigated by agencies like the FBI, DEA, and Department of Health and Human Services. Penalties are severe, including:

• Fines up to $250,000 per false claim
• Up to 10 years in federal prison per offense
• Exclusion from federal healthcare programs
• Loss of professional licenses

Even an investigation alone can damage your reputation and career. Prosecutors aggressively pursue these cases to recover losses and deter future fraud. 1

What to Do If Accused

If accused of healthcare fraud, the first step is to hire an experienced federal criminal defense attorney immediately. Do not speak to investigators without legal counsel present.Your attorney will:

• Analyze the charges and evidence against you
• Advise you on navigating the investigation process
• Develop a strategic defense tailored to your case
• Negotiate with prosecutors for reduced charges or penalties
• Represent you in court if charges are filed

Spodek Law Group has over 50 years of combined experience defending clients nationwide against federal healthcare fraud charges. We understand the complexities of these cases and fight aggressively to protect your rights. 1

Building a Healthcare Fraud Defense

Potential defenses against healthcare fraud charges depend on the specific circumstances. Some common strategies include:

• Lack of intent to defraud
• Billing errors or mistakes
• Entrapment by investigators
• Challenging the prosecution’s evidence and witnesses

Your attorney will thoroughly investigate the allegations, scrutinize the government’s case, and identify any weaknesses or legal issues that can be leveraged in your defense. 1

Avoiding Healthcare Fraud Charges

The best way to avoid healthcare fraud charges is through comprehensive compliance programs and training. This includes:

• Implementing policies and procedures to prevent errors
• Conducting regular audits and monitoring
• Providing staff education on fraud laws and regulations
• Maintaining detailed patient records and billing documentation
• Promptly self-reporting and correcting any identified issues

Even accidental mistakes can raise suspicions, so diligence is crucial for healthcare providers and organizations. 1