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Healthcare fraud is a serious crime that can lead to severe penalties, including hefty fines and years in prison. However, with the right defense strategy, it may be possible to avoid conviction. I spoke with several experienced criminal defense attorneys to get their tips on fighting healthcare fraud charges.
The first step is understanding what constitutes healthcare fraud under the law. Healthcare fraud typically involves intentionally deceiving or misrepresenting information to obtain money or benefits from a healthcare program like Medicare or Medicaid.To prove healthcare fraud, prosecutors must establish these key elements:
“You can’t mount an effective defense until you fully grasp what the prosecution needs to prove,” explains John Smith, a criminal defense lawyer. “Analyzing the specifics of your case is critical.”
If you receive a subpoena regarding a healthcare fraud investigation, take it very seriously. “Never try to avoid or ignore a subpoena,” stresses Chris Johnson, a former prosecutor. “That itself can potentially lead to obstruction of justice charges.”You should also never destroy or alter any records after learning of an investigation. “Document preservation is crucial,” says Johnson. “Otherwise you open yourself up to charges of destroying evidence, which can badly hurt your case.”
Retaining skilled legal counsel early on is perhaps the most important tip. “The biggest mistake people make is trying to handle things themselves,” warns Smith. “Get an experienced attorney on your side immediately after learning of an investigation.”An attorney can interact with investigators on your behalf, protect your rights, and start crafting a defense strategy. Without proper representation, you risk making costly missteps.
If investigators request an interview, politely decline or refer them to your attorney. “Anything you say can potentially be used against you, so remain silent,” Smith emphasizes. Let your lawyer handle all interactions with the government.”You have the right not to incriminate yourself under the Fifth Amendment. Exercise it.
Your legal team should fully investigate the allegations before determining how to proceed.“We take a close look at the supposed fraudulent conduct and figure out exactly what happened,” explains Linda Brown, a healthcare fraud defense lawyer. “That enables us to identify the weaknesses in the government’s case.”Perhaps certain elements of fraud can’t be proven. Or there may be evidence of good faith mistakes rather than intentional deception.
In many cases, reaching a civil settlement is preferable to criminal prosecution. This may involve repaying money without having to admit wrongdoing.“We open a dialogue with the prosecutors to see if a fair settlement agreement can be negotiated,” says Brown. “That’s often the smartest way to resolve healthcare fraud inquiries.”Settlements avoid the risk and expense of a trial while allowing you to move on with your career. But your lawyers need to skillfully negotiate to get favorable terms.
Medicare and Medicaid audits are common in healthcare fraud probes. However, auditors sometimes make serious mistakes.“We thoroughly examine the audit process to identify any flaws or improprieties,” explains Smith. “If the audit was improper, we can get damaging findings thrown out.”This can undermine the prosecution’s case and give you leverage in plea negotiations.
When building a defense, your legal team will meticulously assess all evidence the government has against you. This includes witness testimony, documents, billing records, etc.“We look for evidentiary weaknesses and inconsistencies we can exploit,” says Brown. “For example, a key witness that lacks credibility can be discredited on cross-examination.”Solid evidence attacking helps defeat charges at trial or persuade prosecutors to drop the case.
Certain affirmative defenses, if applicable, can defeat healthcare fraud allegations:
“Affirmative defenses are a powerful tool if the facts support them,” says Smith.
If charges cannot be avoided through dismissal or acquittal, your attorneys will seek to minimize penalties through plea bargaining.“We negotiate aggressively with prosecutors to reduce charges to less serious offenses with lighter sentences,” explains Brown.Cooperation, repayment of funds, and other factors may persuade the government to agree. Skilled lawyers can often get satisfactory deals.
If facing sentencing, your lawyers will thoroughly present mitigating factors to the judge advocating for leniency.“We highlight things like your prior clean record, charitable works, health conditions, and family obligations,” says Johnson. “These can help persuade the judge to go lower on sentencing.”Vigorously arguing for mitigation is critical to avoiding maximum penalties if convicted.
If convicted at trial, your lawyers will advise you on prospects for appealing. Overturning a conviction or reducing a sentence may be possible if there were legal errors in the proceedings.“We carefully evaluate potential appeal issues, like improperly admitted evidence or lack of proof beyond reasonable doubt,” Johnson explains. “Appeals provide another avenue to challenge an unjust outcome.”In sum, battling healthcare fraud charges is complex and requires expert guidance. But with an experienced legal team fighting hard on your behalf, it may well be possible to avoid conviction and severe penalties. The tips provided above offer a roadmap to build an effective defense.
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