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Healthcare defense: Understanding healthcare fraud lawyers

June 30, 2020

Healthcare fraud has continued to be a major concern for the Federal government. This is because of the increasing number of fraud cases being reported every day.

It is estimated that the government loses 3 percent of the total healthcare budget to fraudulent claims every year.

As such, the government is stepping up its fight against healthcare fraud in the country.

The Department of Health and Human Services, local attorney generals, and the Office of the Inspector General have combined efforts to ensure that anyone found culpable for healthcare fraud is prosecuted.

Investigations related to healthcare fraud rely on previous employees, confidential informants, and any other person who can provide incriminating evidence to the investigators.

This means that incidences of negligence or administrative errors can be flagged as healthcare fraud.

Over the past few years, the federal government has increased healthcare funding across the states. This has also led to a rise in healthcare fraud auditing. That’s why most healthcare professionals often found themselves being investigated for healthcare fraud.

This is where healthcare fraud lawyers come in. The first thing to do when you are informed of a potential healthcare fraud investigation is to contact an experienced lawyer.

There are several lawyers who specialize in healthcare fraud cases and will be able to handle your case in a more professional manner.

Some healthcare professionals often find themselves on the wrong side of the law simply because they don’t fully understand what healthcare fraud means. Some get caught up due to carelessness while others as a result of honest administrative errors.

Below are some common examples of healthcare fraud:

• Submitting false claims to insurance companies with the intention of receiving money
• Receiving kickbacks and referrals fees
• Billing for non-existent patients
• Billing for healthcare services not rendered
• Up-coding
• Presenting misleading information to insurance companies to get paid
• Giving false information while applying for Medicare and Medicaid programs
• Billing for equipment that was not offered
• Utilizing excluded providers

Healthcare fraud charges and defense

Healthcare fraud cases are usually investigated by the Federal Bureau of Investigation (FBI), Drug Enforcement Authority (DEA) and the Office of the Inspector General.

After the investigations, the cases are then prosecuted by the United States Attorney from the Office of the Department of Justice.

Healthcare fraud cases are prosecuted under the flowing three acts:

1. Fraud 18 U.S.C 1347

Under this act, prosecutors target pharmacists, physicians, and other health practitioners suspected to be giving improper prescriptions, dispensing, and administering wrong medicine to patients.

Besides medical services, investigators also try to find out if prescription medicine and medical supplies are qualified for Medicare and other federal government program reimbursement.

Falsifying patient records in order to receive higher amounts by medical practitioners can easily trigger investigations.

2. Medical Anti-kickback statute

Under this statute, it is unlawful for any healthcare practitioner or provider to give payment or remuneration either indirectly or directly in kind or in cash to anybody to get a patient referral within the healthcare program.

3. False claims Act

The False Claims Act is one of the most powerful arsenals used by the federal government to prosecute healthcare fraud. It is an extraordinarily wide statute that places both criminal and civil liability for any fraudulent or false claim submitted for reimbursement in the federal healthcare programs.

False claims here refer to all billing errors, coding errors, certification among others that any healthcare provider makes relating to a payment claim.

The regulations governing federal reimbursement are complex and are often used by government prosecutors to charge anyone found violating those rules.

Anyone charged with healthcare fraud may also face extra criminal charges including the following:

• Forgery
• Conspiracy
• False statements
• Money laundering

Penalties and punishment for healthcare fraud

Those found guilty of healthcare fraud face the following punishment and penalties:

• Professional discipline
• Lose of the operating license
• One can be excluded from taking part in state and federal health programs such as Medicaid and Medicare
• Jail term
• Monetary fines

Healthcare fraud defense

What might appear simple administrative errors or carelessness can end up as formal criminal charges in a court of law. In case the prosecutor allows for investigations to proceed, you will be formally informed through a letter or phone call.

The first thing to do once you receive that call or letter is to contact an experienced healthcare fraud defense lawyer.



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