What is Health Care Fraud?
Health care fraud is a type of white-collar crime where people, usually doctors or clinics, charge for services that were not medically necessary or never provided. The first law against this kind of crime was introduced in 1996. The law is called the Health Insurance Portability and Accountability Act, or HIPAA for short. HIPAA created a program to fight health care fraud. This type of fraud can be prosecuted by the federal government both civilly and criminally.
The main federal health care fraud statute is 18 USC § 1347, which states that you can be held criminally responsible if you try to cheat a health care benefits program or use false statements to get money from a health care benefits program.
Most federal health care fraud cases occur when someone falsely bills Medicare, Medicaid, or other health care organizations that are run by the federal government. Health care fraud accounts for over $100 billion every year in the United States. Investigating health care fraud is considered a high priority for the FBI‘s Complex Financial Crime Program. Make sure to have an experienced attorney's help if you are facing allegations related to healthcare fraud.
What Are Some Examples of Health Care Fraud?
The federal government has prosecuted many varieties of health care fraud cases. Some common examples include:
- A physician who ran a “pill mill” and distributed controlled substances that resulted in the death of a patient
- A doctor who was involved in a scheme to defraud Medicare by receiving kickback payments for medically unnecessary home health referrals
- A physician who operated a sleep study scam by paying people to be part of a non-existent sleep study so he could fraudulently bill medical insurance companies
- A doctor fraudulently billing for visits and tests that never occurred
- A doctor taking bribes to prescribe fentanyl
- A physician giving medically unnecessary treatments to patients resulting in injuries to the patients
There are many different ways a doctor or organization can commit the crime of Health Care Fraud. For example, they can bill for services that were not provided or give patients treatments that are not needed, and which might hurt or kill them.
What Are the Potential Penalties of a Health Care Fraud Conviction?
The penalties for a health care fraud conviction can be significant. Generally, they are as follows:
- A conviction will result in up to 10 years in federal prison if there is no injury to any victim.
- A conviction will result in up to 20 years in federal prison if there is a serious bodily injury to any victim. This includes injuries that involve serious risk of death, extreme physical pain, disfigurement, or the loss of a body function.
- A conviction will result in up to a life sentence if any victim dies.
A conviction can also result in significant amounts of restitution and fines from the court. An individual can be fined up to $250,000 per healthcare fraud offense, while an organization can face a fine of up to $500,000 per healthcare fraud offense. It is critically important to understand the potential penalties in your case to best choose your path forward.
What Are Some Common Defenses to Health Care Fraud Charges?
There are several defenses that can be available to defend against a health care fraud charge. To prove that you committed health care fraud, the prosecutor has to show that you had a criminal intent to enrich yourself by using a false claim or activity. A common defense is that you made a mistake. In order for something to be considered fraud, it must be shown that the act was intentional and done on purpose. There are other defenses too. Did your Constitutional rights get violated? Is there enough evidence? Has the right kind of accounting been done? These are just some of the questions your lawyer will ask as they build your defense if you are charged with health care fraud.
In What Court Will Your Case Be Heard?
Federal criminal cases are processed in federal District Court. If your case starts in Pennsylvania, then it will be heard in one of three federal districts. The three Pennsylvania federal districts are the Central, Middle, and Eastern districts. If the allegations in your case refer to conduct in central or eastern Pennsylvania, then the case will be heard in the Middle District Court or the Eastern District Court.
How Hiring an Experienced Attorney Can Help
If you are facing criminal charges, it is important to have a lawyer with experience. An experienced lawyer can help you understand the charges and the evidence against you. They will be able to tell you what defenses might be available to you in court. An attorney can also help you determine if a trial is the best option or if it would be better to work out a deal with the prosecutor and judge.
If you decide to resolve your case, then your attorney can help you negotiate a resolution. This would typically involve a guilty or no contest plea to a certain charge in exchange for a reduced sentence or other benefits. Make sure that you understand everything about your case and the potential consequences of a conviction before making any decisions. Call us with your questions.
Why Hiring LLF Law is the Right Choice
If you are being investigated or prosecuted federally for health care fraud, then it is important to speak to an experienced federal criminal defense attorney right away. Our Criminal Law Team has helped people defend countless criminal charges in several jurisdictions. Call the LLF Law Firm today at 888-555-3686 to learn why hiring LLF Law is the right choice to help defend your federal case.
