A Guide on Attorneys for Healthcare Fraud

Healthcare Fraud

In this day and age, healthcare fraud has been at a drastic increase in the United States. As a result, there is a genuine possibility of a lawsuit filed against you. But just because some people out there commit such crimes doesn’t mean that everyone else does as well. So how does one present their case when they are confident that they didn’t do anything wrong? The answer you’re looking for is a knowledgeable attorney. 

If you plead your innocence in court, a lawyer could help strengthen your defense in front of the judge. Nevertheless, a case on healthcare fraud may have many different outcomes. But before looking into that, let’s discuss healthcare fraud. 

What is Healthcare Fraud?

Healthcare fraud includes attempts to defraud or falsify health claims to the government or obtaining self-referrals. Since no one statute controls healthcare fraud, health care law is multifaceted. Instead, medical professionals must traverse a tangle of rules to avoid criminal and civil prosecutions for healthcare fraud, bribes, referrals, and fraudulent claims. As a defendant, you might face charges under any of these acts, which could result in prison time, hefty fines, and the loss of your medical licensing.

Also Read: Major Types Of Health Insurance Policies

A physician, hospital, or other health care providers are frequently guilty of fraud when they charge for products or procedures that were either not supplied to a patient or were not medically appropriate. Fraudulent bills filed to federal government plans or private insurance businesses are the basis for the majority of health care fraud prosecutions. Informants who disclose unlawful activities, including patients, office employees, hospitals, or former business partners, might lead to prosecution. 

But, if you can partner up with a reliable health care fraud attorney, there might still be hope. And if all goes well in a federal criminal trial, you might even get an agreeable plea deal or “not-guilty” verdict. 

Different Types of Healthcare Fraud Charges

In criminal courts, a variety of healthcare fraud offenses can undergo prosecution. The most prevalent, as well as violations that expose you to civil responsibility and have compounding potential with federal charges, are listed below. In their relentless effort to prevent health care fraud, prosecutors generally try both approaches.

Criminal Healthcare Fraud

18 U.S.C. Section 1347, as a federal offense, establishes harsh penalties for healthcare fraud. In a routine prosecution case, a healthcare practitioner accused under the statutory provision might face various penalties. These may include up to $250,00 (for individuals) or $500,000 (for corporations), as well as up to 10 years in federal imprisonment. 

Anti-Kickback Statute

The Anti-Kickback Statute is a penal law that makes it illegal to pay reimbursement. It is applicable in the case where someone encourages or incentivizes patient referrals or creates sales involving any product or treatment covered by the public healthcare systems (e.g., drugs, supplies, or health care services for government plan patients). This scenario is where a drug attorney or some other lawyer might come into the picture. 

False Claims Act

Under 18 U.S.C. § 287, the government needs to prove that the defendant is guilty of the following:

  • creating or presenting false and fraudulent claims to a United States department
  • made such claims even when knowing that it was fictitious and not genuine
  • the defendant’s actions were with the particular intent to violate the law, or while already knowing that their actions were wrong

Stark Law – Physician Self-Referral Law

Unless an exemption exists, the Physician Self-Referral Law, often known as the Stark law, restricts physicians from making referrals to organizations with whom the doctor or an immediate family member has a direct connection for “specified health services” reimbursed by government plans. Both ownership/investment holdings and remuneration structures are part of financial connections. For instance, if you invest in an imaging clinic, the Stark legislation requires the ensuing financial connection to fall inside an exemption. If it does not, you can’t refer clients to the unit, and the organization can’t charge for the given diagnostic services.

Health Care Fraud Conspiracy

Anyone who attempts or actively works to perpetrate an infraction under this chapter faces the same consequences as those who commit the offense whose commission was the goal of the attempt or conspiracy.

Wire and Mail Fraud

In layman’s terms, anyone attempting to defraud other individuals or organizations using any means of communication, such as telephones, text messages, emails, or letters, signs, photos, or recordings, can face a maximum penalty of 20 years in jail. If a financial institution is involved in the scheme, the maximum fines increase to one million dollars, and the jail sentence is approximately 30 years or even both.

Conspiracy to Defraud the Government through Claims

Anyone who enters into an accord, combination, or conspiracy to deliberately defraud the United States, or any government department thereof, by obtaining or trying to acquire payment or stipend of any falsified, fictional, or bogus claim shall be punishable with fines or by imprisonment for ten years. 

Potential Defenses in Healthcare Fraud Cases

With the help of an attorney, you can take advantage of many obvious defenses that may weaken the prosecution’s case. The following are a few of the many possibilities:

  • Lack of Intent: When it comes to fraud punishment, the intent behind your actions plays a crucial part. According to the law, you are only punishable if you willingly cheat the government’s medical plans or a private insurance entity. But if your actions were the result of an honest mistake, the prosecution’s case automatically weakens. 
  • Inadequate Evidence: The government needs proof of your actual intent, and it needs sufficient information to establish it beyond a rational dispute. You can’t undergo conviction if there isn’t enough proof.
  • Compliance Programs: An expert lawyer can assist you in developing a comprehensive compliance plan to detect and prevent fraud in your profession or organization. Evidence of a complete compliance strategy might be applicable to demonstrate that you had no intention of defrauding the healthcare system.

Taking the Help of a Healthcare Fraud Defense Attorney

In federal district courts around the nation, healthcare lawyers successfully defend individuals and corporations accused of health care fraud. Moreover, they accomplish dismissals, advantageous plea agreements, and “not guilty” judgments for many such clients. It’s crucial since a felony conviction may ban you from practicing law.

The legislation governing health care is complex, and an expert health care defense lawyer can assist you in navigating these harsh accusations. Before trial, they will employ successful pretrial motions to weaken or limit the prosecution’s position. These lawyers can successfully argue over many specific propositions to dismiss evidence, enabling the clients to win their lawsuits even before trials. But in case you do enter a plea, they’ll make sure it doesn’t result in professional or licensing actions.

Such lawyers have the knowledge and expertise to oppose even the most complicated healthcare fraud claims. They work with former government agents as researchers and analytical economists to help them evaluate the valuable medical billing data that are typically a vital element of effectively disputing these charges. They also recruit health care providers and other medical specialists to examine the government’s allegations to identify areas where the case may be vulnerable to a table-turning rebuttal. 

Final Thoughts

Healthcare fraud is no laughing matter and could leave you facing hefty fines and lengthy jail sentences. So if you are unfairly facing any such charges, make sure you reach out to a healthcare fraud defense attorney. 

About Robert James

My name is Robert James admin of Storifygo and I am a student at the Comsats University Islamabad. I started my graduation in 2016 and graduated in 2020. I'm a professional article and blog writer, have written dozens of content on different topics, and worked with professionals all over the globe. Feel free to contact me for any assistance. [email protected]

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