Healthcare Fraud Defense Attorney Explains Criminal Conduct

In 2016, the Department of Justice obtained $2.5 billion in judgements and settlements in healthcare fraud claims. Civil cases are just the start of the penalties that could result if a defendant has been accused of a healthcare fraud offense. More seriously, defendants who are accused of healthcare fraud could face criminal charges, jail time, loss of their professional licenses, damage to their reputation, and other serious life-changing and career ending consequences.

If you have been accused of healthcare fraud or you are under investigation for potential fraud, it is vital to take the charges seriously because the consequences can be so harsh if you are found to have committed fraud.

You need to do everything possible to defend your good name, avoid criminal or civil proceedings, and protect your finances and future.

LV Criminal Defense can help. Our federal medical fraud defense attorneys provide representation to clients in California, Arizona, Oregon, Nevada, Utah, or surrounding areas and we are prepared and ready to help you develop a comprehensive defense strategy that addresses all of the key legal issues you are facing.

Give us a call today to find out more about the assistance we can offer in fighting charges of Medicare fraud.

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Nick Wooldridge has a long track record of representing clients accused of serious federal and state crimes in Nevada.


Civil and Criminal Laws on Healthcare Fraud

There are many federal rules and regulations that impose penalties for the offense of healthcare fraud and abuse. Some of the relevant laws that could apply to your case include:

  • 18 U.S. Code Section 1347: This statute imposes a penalty of up to 10 years of imprisonment for obtaining health care benefits by false means or for knowingly defrauding any healthcare benefits program. A defendant convicted under this statute can also be fined for knowing fraud in connection with a healthcare program or obtaining healthcare services.
  • 42 U.S. Code section 1320a-7b: This statute imposes criminal penalties for knowingly making, or causing to be made, any false statements in applications for benefits under federal healthcare programs. Knowingly and willfully making false statements, or causing them to be made, in relation to any material fact used to determine payment for healthcare benefits can result in criminal charges under this statute. Defendants can also be charged for kickbacks, which means knowingly and willfully receiving or paying money or items or value in return for referring an individual for care that will be paid for by a federal healthcare program. Even offering to pay kickbacks can lead to charges. These and other offenses made illegal under 42 U.S. Code section 1320a-7B can result in federal criminal charges and a lengthy period of imprisonment.
  • 18 U.S. Code section 1035: This statute imposes a penalty of up to five years of imprisonment for knowingly concealing, falsifying, or covering up material facts or making materially false statements or documents in connection with the payment of healthcare benefits.
  • The False Claims Act: The False Claims Act helps the federal government to combat Medicaid and Medicare fraud by prohibiting the knowing submission to the government of a false claim for payment. Causing false claims to be submitted is also prohibited under the False Claims Act. This Act incentivizes whistleblowers to come forward and report fraud and abuse by providing them with a portion of the money recovered from the defendant found to have committed fraud. Those who are found to have engaged in fraudulent or false claims can owe triple damages as well as additional civil penalties.
  • Stark Law: Stark Law prohibits doctors from referring Medicare patients for services or care to any person, facility, or other entity that the referring doctor has any kind of financial relationship with. Doctors who violate this law may be forced to return payments received due to referrals and to pay civil and criminal penalties. They may also be excluded from participating in Medicare going forward.
  • 42 U.S. Code Section 1320a-7a: This statute civil penalties for improperly filed claims for medical services that were not provided or that were medically unnecessary but were provided to pad a bill. Penalties are also imposed for submitting insurance claims for services not provided by a licensed physician or for up-coding, which means submitting a claim for payment for a more expensive product or service than the one which was actually provided.

LV Criminal Defense has extensive experience providing representation to defendants facing legal consequences under all of these different statutes.

We can help you to develop a comprehensive defense strategy focusing on responding to both civil and charges and working to protect your professional reputation, your career, your finances, and your freedom.

Types of Healthcare Fraud Crimes

Many different types of misconduct could result in a charge of healthcare fraud. Some of the common examples of fraudulent behavior for which care providers could face consequences include:

  • Illegal kickbacks: Doctors or other care providers who provide items of value in exchange for patient referrals can face criminal charges. Even offering to pay for referrals could result in charges.
  • Up-coding: Charging an insurer more for services than a care provider should receive can result in criminal charges for healthcare fraud. Up-coding could include charging for a more expensive service than the service which was provided. Unbundling is also a form of up-coding and it occurs when services that should be billed together under one code are instead broken out into multiple services that are each billed for separately.
  • Providing unnecessary medical services: Care providers who provide services a patient does not need can be considered to have committed healthcare fraud. This can include hospitals who admit patients unnecessarily, or any other care provider that offers services not medically necessary.
  • Durable medical equipment fraud: This type of fraud occurs when suppliers promise a patient that he or she will receive free equipment but then the supplier bills Medicaid or Medicare. It can also include doctors prescribing durable medical equipment a patient does not need, or billing for medical equipment that a patient did not actually receive.
  • Home healthcare fraud: Billing for home healthcare services that were not performed, or billing for services for ineligible patients.

LV Criminal Defense can provide help if you are accused of these healthcare fraud crimes or related offenses.

What Our Client are saying

When I initially met with Mr. Wooldridge, he took the opportunity to sit and go over my problem with me. He described details in my case which he found disturbing and explained why he I should have him on my side.

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Useful Resources

CMS – Laws Against Healthcare Fraud

U.S. Department of Health and Human Services – Office of Inspector General

Department of Justice – Health Care Fraud and Abuse Control Program

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Getting help from a Federal Healthcare Fraud Lawyer

A federal healthcare fraud lawyer at LV Criminal Defense can provide dedicated, personalized advice as you fight serious charges. Give us a call today to learn more.