Orlando Healthcare Fraud Defense Attorney

What Is Healthcare Fraud?

Healthcare fraud can be pursued as both a civil lawsuit and a criminal prosecution. Criminal prosecution for healthcare fraud at the federal level is primarily governed by 18 U.S. Code § 1347, healthcare fraud is defined as:

“Knowingly and willfully executing, or attempting to execute, a scheme or artifice to:

• To defraud any health care benefit program OR
• To obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program

in connection with the delivery of or payment for health care benefits, items, or services.”

One important thing to note about the federal Healthcare Fraud Statute is that it specifically states “…a person need not have actual knowledge of this section or specific intent to commit a violation of this section.” In practical terms, that means the prosecution is not required to prove that you had the intent to commit the crime nor that you had explicit knowledge of the crime to secure a conviction.

What Are Some Common Examples of Healthcare Fraud?

Healthcare fraud investigations and/or prosecutions typically involve a practice or scheme to obtain funds from Medicare, Medicaid, Tricare, and other federal healthcare benefit programs through improper means. Precisely how healthcare fraud is carried out can vary dramatically; however, some common methods used in healthcare fraud schemes include:

• Double billing. This involves submitting multiple identical claims for the same service.

• Phantom billing. As the name implies, phantom billing occurs when a provider bills for a service visit or supplies that the patient never received.
• Unbundling. This is another way to submit multiple bills for the same service by billing complex, multi-step procedures separately, instead of as one coded procedure. Unbundling results in a higher overall payment because the services are billed individually.
• Upcoding. This involves billing for a more expensive service than the patient actually received.
• Improper coding. Providers may intentionally submit claims using the incorrect code for the service rendered to get reimbursed for a non-covered service or to get a higher rate of reimbursement for a covered service.
• Kickbacks. Accepting kickbacks for patient referrals is also a type of healthcare fraud that is covered under a separate statute known as the “Federal Anti-Kickback Statute.”

 

What Is the Potential Penalty for Healthcare Fraud?

A conviction for healthcare fraud carries with it a potential punishment of up to 10 years in prison and/or a fine of up to $250,000 for an individual or $500,000 for an organization. If serious bodily injury or death occurs in connection with healthcare fraud, you face up to 20 years in prison or life in prison, respectively.

What Does It Mean If I Received a “Target Letter?”

When the federal government is investigating “white collar” fraud schemes, such as healthcare fraud, they often notify suspects in the investigation by sending them a “target letter.” A target letter will identify the criminal offense being investigated and may ask you to produce documents, contact federal law enforcement agents or attorneys, or appear before a Grand Jury. If you receive a target letter, it is imperative that you contact an experienced healthcare fraud defense attorney before complying with any requests contained in the letter to ensure that your rights are protected.

Get Help from an Experienced Healthcare Fraud Defense Attorney

If you are the target of a healthcare fraud investigation or you have been formally charged with committing healthcare fraud, you must act quickly to protect your rights, your professional future, and even your freedom. The complex nature of most healthcare fraud prosecutions means that you may have several important defenses available; however, the viability of those defenses may decrease if you do not get an experienced healthcare defense attorney onboard as soon as possible.

Consult with a federal healthcare fraud defense attorney at Haas Law immediately and let us put our extensive experience, vast resources, and proven commitment to work protecting your rights and defending you against accusations of healthcare fraud.

Call us at 407-755-7675, chat with us online, or submit our online form today. Because we understand that time is of the essence when federal law enforcement authorities are investigating you, our calls are answered 24 hours a day, allowing you to schedule an appointment as soon as possible to discuss your legal options.