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Health Care Fraud Charges
Health care fraud charges usually involve a doctor, clinic, or other health care provider charging for goods or services that were either not actually provided to a patient or were not medically necessary. Most health care fraud cases are based on false bills submitted to Medicare, Medicaid and TRICARE, although some of these crimes can also cover false bills sent to private insurance companies.
Our firm has successfully defended people and businesses charged in health care fraud cases in federal district courts across the country. We have obtained dismissals, favorable plea deals, and “not guilty” verdicts for our clients in federal criminal trials.
Health Care Fraud Charges and Penalties
There are many different types of health care fraud offenses in federal court. Here are some of the ones most frequently used by federal prosecutors when they charge a person with a health care fraud offense in federal court:
Health Care Fraud (18 U.S.C. §1347) – This code section is the basic health care fraud statute in federal court. This law makes it illegal to make a false statement or promise to defraud a health care program. This law covers fraud involving both government sponsored health care programs and private insurance companies. The penalty for this type of health care fraud is up to 10 years in prison, although the federal sentencing guidelines may call for a much lower sentence depending on the amount of money involved in the case.
Health Care Fraud Conspiracy (18 U.S.C. §1349) – This code section covers conspiracies to commit a healthcare fraud offense. This law makes it illegal for two or more people to agree to a scheme or plan to commit some form of health care fraud. The plan doesn’t have to be successful for someone to be convicted of this crime. All the government has to prove is that there was an agreement to do something that violates the health care fraud laws. While there are several different conspiracy laws that may apply in a health care fraud case, this is the one we see prosecutors use most often. A person convicted of a health care fraud conspiracy faces up to 10 years in prison.
Wire and Mail Fraud (18 U.S.C. §§ 1341 and 1343) – This code section covers any type of fraud, not just health care fraud, where a person uses the mail or some type of wire communication to cheat someone out of money. Although these sections can cover the same type of conduct covered by the basic health care fraud statute, prosecutors like to use these offenses so they can threaten a defendant with a lengthier sentence. A person convicted of wire or mail fraud faces up to 20 years in prison in most cases.
False Claims Law (18 U.S.C. §287) – This code section makes it illegal to submit a false claim (like an invoice for medical services or equipment) to the government for payment. Most cases brought under the False Claims Act involve a health care provider submitting bills for medical services or equipment not provided to a patient, or that were not medically necessary for the patient. The penalty for violating this law is a sentence of up to 5 years in prison.
Anti-Kickback Law (42 U.S.C. §1320a-7b) – This law makes it illegal for someone to pay or receive a “kickback” (a bribe, gratuity or other payment) in connection for medical services or equipment paid for by a government sponsored health care program. Most anti-kickback cases involve money or other benefits given to a doctor or clinic for referring patients or sending business to another health care provider. This section only covers bills sent to a government health care program, like Medicare, Medicaid or TRICARE. A violation of this law carries a sentence of up to 5 years in prison, although the specific sentence will usually be based on the federal sentencing guidelines.
Defenses to a Health Care Fraud Case
The most common defense to an allegation that a person has committed health care fraud is that the person did not have the intent to defraud anyone. That means that the person was acting in good faith when they submitted what may have been a false bill or claim. To convict someone of violating most health care fraud laws, the government has to prove that the person submitted a false claim with the intent to cheat the insurer out of money. If the government can’t show that the person had that intent, then the person is not guilty. And that’s true even if the bill or claim was actually false.
In health care fraud cases, like any other federal criminal case, we will always try to use effective pretrial motions to gut or narrow the government’s case before trial. If the government is relying on evidence it obtained during a search of a person’s residence, business or computer data, we will usually file a motion to suppress that evidence. Over the past 20 years, we have successfully argued many motions to suppress and have helped our clients win their cases even before trial.
Our firm has the experience and resources necessary to defend even the most complex health care fraud cases. We have close relationships with former federal agents who we employ as investigators and forensic accountants to assist us in reviewing the extensive medical billing records that are usually a big part of successfully defending these cases. We also hire physicians and other medical experts to review the government’s allegations to show us where the case may be weak and subject to a successful challenge.
If you or someone you know is charged with any type of heath care fraud in federal court, feel free to call Kentucky federal attorney J. Clark Baird to discuss the case in complete confidence. We represent clients in Medicare fraud, Medicaid fraud and TRICARE fraud cases in federal courts across the country.
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