How Attorneys Beat Allegations of Home Healthcare Fraud
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How Attorneys Beat Allegations of Home Healthcare Fraud
Home healthcare fraud is a big issue. The government estimates that over $10 billion of the $18 billion spent on home healthcare in 2015 was lost to fraud. But just because an attorney’s client is accused of fraud doesn’t mean they’re guilty. Good attorneys work hard to beat the allegations. Here’s how they do it:
Understanding the Allegations
The first thing an attorney does is fully understand the allegations. Common home healthcare frauds include:
- Billing for services not provided
- Billing for services not medically necessary
- Kickback schemes with doctors
- Identity theft or using someone else’s insurance
By studying the allegations closely, the attorney can start to poke holes in the government’s case. For example, if the government alleges certain dates where fraud took place, the attorney can try to prove their client was somewhere else on those dates.
Examining the Evidence
Next, the attorney digs into the evidence. They’ll look at medical records, bills, patient testimony, doctor relationships, etc. The goal is to find facts that contradict or weaken the government’s accusations.
Sometimes the evidence is based on the testimony of disgruntled former employees or competitors. The attorney will work to undermine their credibility. Other times, sloppy record-keeping leads to innocent mistakes looking like fraud.
Using Legal Technicalities
Experienced attorneys also leverage legal technicalities to get charges dismissed. For example, problems with how evidence was obtained or how the investigation was conducted. Attorneys look for:
- 4th Amendment violations related to illegal searches
- 5th Amendment violations around right to remain silent
- Issues with warrants or subpoenas
- Entrapment by investigators
While technicalities don’t prove innocence, they can prevent the government from bringing their case to trial.
Negotiating Settlements
Even solid fraud cases often end in settlements instead of trials. An experienced attorney works to negotiate a favorable settlement for the client. This may involve:
- Admitting to lesser charges
- Repaying overpayments without penalties
- Avoiding being excluded from Medicare/Medicaid
Settlements allow clients to move on without long, expensive court battles they may lose.
Fighting in Court
When settlement talks fail, the fight moves to the courtroom. Attorneys work tirelessly to instill reasonable doubt in the jury’s mind. This involves:
- Discrediting witnesses on cross-examination
- Bringing forth experts supporting the defendant
- Focusing on flaws in the prosecution’s arguments
Juries want to see concrete evidence before convicting. Savvy attorneys highlight where evidence is missing or doubtful. While risky, taking a stand in court sometimes pays off.
Appealing Convictions
If despite their best efforts the client gets convicted at trial, the attorney can file appeals. On appeal, higher courts take a fresh look for mistakes made by the trial judge or jury. Common appeal arguments include:
- Incorrect rulings on evidence or testimony
- Mistakes in jury selection or instructions
- Prosecutorial misconduct
- Harsh/unreasonable sentences
Appeals give convicted defendants a second chance at justice. Higher courts overturn many convictions due to issues missed below.
Using the Media
Media attention can also help attorneys fight fraud allegations. Coverage showing flaws in the government’s case generates public doubt. It also puts pressure on prosecutors not to overreach.
That said, most attorneys start out keeping allegations quiet to protect their client’s reputation. As the case progresses, selective media outreach helps balance the scales.
Avoiding Future Allegations
If an attorney beats fraud allegations against their client, they don’t stop there. To avoid future issues, the attorney advises steps like:
- Improving record-keeping and oversight
- Regularly auditing bills
- Better training employees on rules
- Screening new hires more carefully
An ounce of prevention beats needing to cure fraud allegations down the road. No one wants to repeat the same painful legal fight.
In the end, experienced attorneys have many tools to beat allegations of home healthcare fraud. From undermining shaky evidence to negotiating settlements to overturning convictions, they work tirelessly for their clients. And if needed, they put improved practices in place to prevent headaches arising again.