What are Healthcare Fraud Crimes?

Healthcare fraud crimes refer to illegal activities that involve deceit, misrepresentation, or manipulation in the healthcare industry to gain financial benefits or advantages. Healthcare fraud is generally a federal felony crime.

Some Common Examples of Healthcare Fraud Crimes Include:

Billing Fraud: Submitting false claims or inflating charges for services or procedures that were not provided or were unnecessary. This could involve billing for services at a higher rate than the actual one.

Kickbacks: Offering or accepting payments, gifts, or other incentives in exchange for patient referrals, services, or goods related to healthcare. Kickbacks can distort medical decisions and compromise patient care.

Upcoding and Unbundling: Upcoding involves billing for a more expensive procedure or service than what was actually performed while unbundling is breaking down a bundled service into separate billable components to maximize reimbursement.

Phantom Billing: Charging for medical services or procedures that were never performed or provided to patients.

Identity Theft: Using someone else’s identity, insurance information, or personal details to receive medical services or prescriptions fraudulently.

Prescription Fraud: Forging prescriptions, altering the quantity or medication prescribed, or obtaining prescriptions without a legitimate medical need.

False Certifications: Providing false information or certificates to qualify for medical benefits, reimbursements, or government programs.

Home Healthcare Fraud: Billing for unnecessary home healthcare services or providing substandard care to patients.
Medical Equipment Fraud: Fraudulent billing or misrepresentation of medical equipment or devices that were not provided or needed.

Medical Identity Theft: Stealing someone’s medical information to obtain healthcare services or prescriptions under their name.

Double Billing: Charging more than once for the same healthcare service or submitting duplicate claims.

Falsifying Medical Records: Altering or fabricating medical records to support fraudulent claims or conceal improper practices.

Penalties

The penalties for healthcare fraud crimes vary depending on the specific jurisdiction and the severity of the offense. In the United States, healthcare fraud is typically prosecuted under federal law, and penalties can include:

Criminal Penalties: Those convicted of healthcare fraud face significant fines and imprisonment. The length of imprisonment can vary depending on the specific charges, the amount of money involved, and the number of violations. In some cases, individuals may face decades in prison.

Civil Penalties: Healthcare fraud can also lead to civil penalties, which involve the payment of fines or damages. These penalties are separate from any criminal penalties and are often intended to recover funds lost due to fraudulent activities.

Restitution: Courts will order convicted individuals or organizations to pay restitution to the victims or the defrauded healthcare programs. This is meant to compensate for the financial losses caused by the fraudulent activities.

Exclusion from Healthcare Programs: Healthcare professionals or entities found guilty of healthcare fraud are likely to be excluded from participating in federal healthcare programs, such as Medicare and Medicaid. This exclusion can have severe consequences for their ability to practice or operate in the healthcare industry.

Professional License Revocation: Healthcare providers found guilty of fraud may have their professional licenses revoked or suspended, preventing them from practicing in their respective fields.

Asset Forfeiture: If healthcare fraud involves the acquisition of assets or property through illegal means, those assets may be subject to forfeiture, meaning they are seized by the government.

Penalties can be severe to deter individuals and organizations from engaging in fraudulent practices. Keep in mind that the specifics of penalties may vary depending on the jurisdiction and the laws in place at the time of the offense. It’s always best to consult with an experienced criminal defense attorney for accurate and up-to-date information on healthcare fraud penalties.

What Does a Healthcare Fraud Criminal Defense Attorney Do?

A healthcare fraud criminal defense attorney is a lawyer who is experienced in representing individuals or entities accused of committing healthcare fraud. Healthcare fraud involves intentional deception or misrepresentation to gain unauthorized benefits from healthcare programs, such as Medicare, Medicaid, or private insurance companies. Healthcare fraud crimes can range from billing for services not rendered to patients, overcharging for services, upcoding (billing for a more expensive service than was provided), and submitting false claims, among other illegal activities.

The Role of a Healthcare Fraud Criminal Defense Attorney Includes the Following:

Legal Representation: The attorney will provide legal representation to the accused throughout the criminal justice process. They will serve as the primary advocate, defending the client’s rights and interests to secure the best result possible.

Case Evaluation: The attorney will thoroughly review the facts of the case, the evidence against the client, and any relevant documentation to understand the strengths and weaknesses of the prosecution’s case.

Defense Strategy: Based on the case evaluation, the criminal defense attorney will develop a defense strategy tailored to the specific circumstances of the case. This may involve challenging the evidence, questioning witness testimonies, and identifying potential legal defenses.

Negotiations: In some cases, the defense attorney may negotiate with prosecutors for a plea deal or reduced charges, aiming to obtain the best possible outcome for their client.

Trial Representation: If the case goes to trial, the attorney will represent the accused in court, presenting evidence, cross-examining witnesses, and making legal arguments to defend against the charges.

Expert Witnesses: In complex healthcare fraud cases, the defense attorney will likely engage expert witnesses, such as medical professionals or forensic accountants, to support the defense’s position.

Compliance Advice: In addition to handling the immediate criminal charges, the defense attorney may also advise clients on compliance with healthcare regulations to avoid future legal issues.

Client Support: Throughout the process, the attorney will provide support and guidance to the client, explaining the legal proceedings and potential consequences, and addressing any questions or concerns.

Appeals: If the case results in an unfavorable verdict, the defense attorney may pursue appeals to challenge the decision.

It’s important to note that healthcare fraud is a serious offense, and individuals or entities facing such charges should seek experienced legal representation to ensure their rights are protected and to navigate the complexities of the legal system. The lawyers at the Attorneys For Freedom Law Firm have over three decades of experience defending clients charged with healthcare fraud felony crimes in federal court. Our attorneys have the experience and knowledge to provide the best possible defense of these charges.

To schedule a Strategy Session with an experienced healthcare fraud criminal defense attorney, contact the Attorneys For Freedom today. We can be reached online at AttorneysForFreedom.com or by calling our Arizona office at 480-755-7110.