How Can I Navigate Federal Health Care Fraud Charges?
Contents
- 1 How Can I Navigate Federal Health Care Fraud Charges?
- 2 Understanding Federal Health Care Fraud Laws
- 3 The Health Care Fraud Statute (18 U.S.C. § 1347)
- 4 The False Claims Act (31 U.S.C. §§ 3729–3733)
- 5 The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
- 6 The Stark Law (42 U.S.C. § 1395nn)
- 7 Wire Fraud (18 U.S.C. § 1343) and Mail Fraud (18 U.S.C. § 1341)
- 8 Common Types of Federal Health Care Fraud Charges
- 9 Potential Penalties for Federal Health Care Fraud
- 10 Key Steps to Take If You’re Facing Charges
- 11 Common Defense Strategies for Health Care Fraud Cases
- 12 Lack of Intent
- 13 Challenging Financial Calculations
- 14 Medical Necessity
- 15 Compliance Program Defense
- 16 Constitutional Violations
- 17 Statute of Limitations
- 18 Entrapment
- 19 Challenging Witness Credibility
- 20 Alternative Explanations
- 21 Why Choose Spodek Law Group for Your Defense
- 22 Frequently Asked Questions About Federal Health Care Fraud Cases
- 23 Don’t Face Federal Health Care Fraud Charges Alone
Are you facing federal health care fraud charges? If so, you’re likely feeling overwhelmed, anxious, and unsure of what to do next. We get it – these types of charges are extremely serious and can have devastating consequences for your career, finances, and freedom if not handled properly.But take a deep breath. With the right legal representation and strategy, it IS possible to successfully navigate federal health care fraud charges and achieve a positive outcome. At Spodek Law Group, we have extensive experience defending clients against these types of charges and know exactly what it takes to build a strong defense.In this comprehensive guide, we’ll walk you through everything you need to know about federal health care fraud charges and how to approach your defense. We’ll cover the laws involved, potential penalties, common defense strategies, and key steps to take to protect yourself. By the end, you’ll have a clear roadmap for how to tackle your case head-on.Let’s dive in!
Understanding Federal Health Care Fraud Laws
The first step in navigating federal health care fraud charges is understanding exactly what laws are involved and what the government needs to prove to convict you. Health care fraud is governed by a variety of complex federal statutes, each with their own nuances.Some of the key laws that are commonly used to prosecute health care fraud include:
The Health Care Fraud Statute (18 U.S.C. § 1347)
This is one of the primary laws used to charge health care fraud. It makes it a crime to knowingly and willfully execute (or attempt to execute) a scheme to:
- Defraud any health care benefit program
- Obtain money or property from a health care benefit program through false pretenses, representations, or promises
To prove a violation, prosecutors must show that you acted with intent to defraud. The maximum penalty is 10 years in prison per count.
The False Claims Act (31 U.S.C. §§ 3729–3733)
This law imposes civil liability for knowingly submitting false claims to the government. It covers a wide range of conduct related to fraudulently obtaining federal health care program funds. Violations can result in treble damages plus penalties of $11,803 to $23,607 per false claim.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
This criminal law prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce referrals for items/services covered by federal health care programs. Violations are punishable by up to 5 years in prison and $25,000 in fines per violation.
The Stark Law (42 U.S.C. § 1395nn)
This civil statute prohibits physicians from referring Medicare/Medicaid patients to entities with which the physician has a financial relationship, unless an exception applies. Violations can result in civil monetary penalties and exclusion from federal health care programs.
Wire Fraud (18 U.S.C. § 1343) and Mail Fraud (18 U.S.C. § 1341)
These broad statutes criminalize using interstate wires or mail to execute fraudulent schemes. They are often used alongside other health care fraud charges and carry penalties up to 20 years in prison.As you can see, federal prosecutors have a variety of powerful tools at their disposal when it comes to health care fraud cases. That’s why having an experienced defense attorney who understands the nuances of these laws is so critical.
Common Types of Federal Health Care Fraud Charges
Now that we’ve covered the key laws, let’s look at some of the most common types of conduct that can lead to federal health care fraud charges:
- Billing for services that were never actually provided
- Upcoding or unbundling codes on claims to increase reimbursement
- Performing medically unnecessary services to generate more billing
- Falsifying patient diagnoses to justify tests, surgeries or other procedures
- Accepting or paying kickbacks for patient referrals
- Prescribing medications in exchange for kickbacks from pharmaceutical companies
- Waiving patient co-pays or deductibles and overbilling insurance to make up the difference
- Misrepresenting credentials, licensing, or certification information
- Falsifying or altering patient records or claims
- Billing for brand name drugs when generics were provided
This is certainly not an exhaustive list, but it gives you an idea of the types of conduct that can trigger federal scrutiny. Even if you didn’t intentionally set out to commit fraud, honest mistakes or sloppy billing practices can sometimes be interpreted as fraudulent.That’s why it’s so important to have robust compliance programs in place and to consult with a health care fraud defense attorney at the first sign of any issues or investigations. The earlier we can get involved, the better we can protect your interests.
Potential Penalties for Federal Health Care Fraud
The penalties for federal health care fraud convictions can be extremely severe. The exact sentence will depend on factors like the specific charges, amount of loss, your role, criminal history, etc. But in general, you could be facing:
- Prison time: Health care fraud convictions often result in federal prison sentences, which could range from a few years to decades depending on the case.
- Massive fines: Fines can reach into the millions of dollars in major fraud cases.
- Restitution: You may be ordered to pay back fraudulently obtained funds.
- Asset forfeiture: The government may seize assets obtained through fraud.
- Loss of licenses: Your medical/professional licenses could be suspended or revoked.
- Exclusion from federal health programs: You could be barred from participating in Medicare, Medicaid, and other programs.
- Civil monetary penalties: Additional civil fines may be imposed on top of criminal penalties.
The collateral consequences can be equally devastating – loss of your career, reputation damage, difficulty finding future employment, etc. That’s why mounting an aggressive defense from day one is so critical.
Key Steps to Take If You’re Facing Charges
If you’re under investigation or have been charged with federal health care fraud, taking the right steps early on can make a huge difference in the outcome of your case. Here are some of the most important things to do:
- Contact an experienced health care fraud defense attorney immediately. Do not speak to investigators without your lawyer present. Everything you say can and will be used against you.
- Preserve all relevant documents and records. Implement a document retention policy to ensure nothing is destroyed or altered.
- Conduct an internal investigation to understand what happened and identify any compliance gaps.
- Review your compliance programs and strengthen them as needed.
- Consider self-disclosure if you’ve identified actual fraud. This can sometimes lead to more favorable treatment.
- Prepare financially for potential fines, asset seizures, and legal costs.
- Maintain confidentiality about the case. Don’t discuss it with anyone other than your attorney.
- Continue operating your business ethically and avoid any appearance of ongoing fraud.
- Cooperate with your defense team fully and provide all requested information.
- Take care of your mental health. These cases are extremely stressful – seek support as needed.
The sooner you take these steps, the better positioned you’ll be to mount an effective defense. Don’t wait until charges are filed to start preparing.
Common Defense Strategies for Health Care Fraud Cases
When it comes to defending against federal health care fraud charges, there are a number of strategies we may employ depending on the specifics of your case. Some common approaches include:
Lack of Intent
Health care fraud requires knowingly and willfully engaging in fraudulent conduct. We may argue that any billing errors or issues were honest mistakes rather than intentional fraud.
Challenging Financial Calculations
The amount of alleged loss is a key factor in sentencing. We often bring in forensic accountants to challenge the government’s loss calculations.
Medical Necessity
For charges related to unnecessary procedures/services, we may present evidence from medical experts supporting the medical necessity and appropriateness of care.
Compliance Program Defense
Having a robust compliance program in place can demonstrate good faith efforts to prevent fraud, even if violations occurred.
Constitutional Violations
We carefully examine the government’s investigative methods for any Fourth Amendment search and seizure violations or Fifth Amendment due process issues.
Statute of Limitations
Health care fraud charges generally have a 5-year statute of limitations. We may argue that some or all charges are time-barred.
Entrapment
In cases involving undercover operations, we may argue that the government improperly induced the defendant to commit fraud.
Challenging Witness Credibility
Many health care fraud cases rely heavily on witness testimony. We work to impeach the credibility of key government witnesses.
Alternative Explanations
We develop alternative, non-fraudulent explanations for the conduct in question whenever possible.The key is tailoring the defense strategy to the specific facts and charges in your case. That’s why working with an experienced health care fraud defense team is so important.
Why Choose Spodek Law Group for Your Defense
When you’re facing federal health care fraud charges, choosing the right defense attorney can literally mean the difference between freedom and incarceration. At Spodek Law Group, we have the experience, resources, and track record of success you need to effectively fight these serious charges.Here’s why we’re uniquely qualified to handle your case:
- Extensive federal court experience: We’ve successfully defended clients against health care fraud charges in federal courts across the country. We know how federal prosecutors operate and how to counter their tactics.
- In-depth health care law knowledge: Health care regulations are extremely complex. Our attorneys have a deep understanding of the relevant laws, regulations, and billing practices.
- Former federal prosecutors on staff: Several of our attorneys previously worked as federal prosecutors. We know how the other side thinks and can anticipate their moves.
- Proven track record: We’ve achieved dismissals, acquittals, and favorable plea deals for many clients facing health care fraud charges.
- Comprehensive defense approach: We leave no stones unturned, examining every aspect of the case for potential defenses.
- Strong relationships: We’ve built strong working relationships with federal prosecutors, which can be invaluable in negotiations.
- 24/7 availability: Federal investigations move quickly. We’re available around the clock to address urgent issues in your case.
- Personalized attention: You’ll work directly with our senior attorneys, not be passed off to junior associates.
When your freedom, finances, and professional future are on the line, you can’t afford to settle for anything less than the best legal representation. Let us put our experience and resources to work for you.
Frequently Asked Questions About Federal Health Care Fraud Cases
We know you likely have a lot of questions about your case. Here are answers to some of the most common questions we hear from clients facing health care fraud charges:Q: Should I cooperate with investigators if I haven’t done anything wrong?A: No – not without an attorney present. Even if you’re innocent, statements you make could be misconstrued or used against you. Always consult with a lawyer before speaking to investigators.Q: Can I just pay back the money to avoid charges?A: Unfortunately, it’s not that simple. Repayment doesn’t negate the original fraud. However, making voluntary repayments can sometimes help in negotiations with prosecutors.Q: What’s the difference between civil and criminal health care fraud cases?A: Civil cases seek monetary penalties and can be brought with a lower burden of proof. Criminal cases can result in prison time and require proof beyond a reasonable doubt. Some cases involve both civil and criminal components.Q: How long do federal health care fraud investigations typically last?A: It varies widely, but major fraud investigations often take 1-3 years before charges are filed. Some drag on even longer. That’s why it’s crucial to get legal counsel involved early.Q: Will my case definitely go to trial?A: Not necessarily. Many federal health care fraud cases are resolved through plea agreements. However, we always prepare as if we’re going to trial so we negotiate from a position of strength.Q: What if I really did commit fraud – is there any hope?A: Yes – there are often still ways to mitigate the damage even if misconduct occurred. Early cooperation, acceptance of responsibility, and proactive remedial measures can all help. The key is getting an experienced attorney involved ASAP to guide your response.Have additional questions? Give us a call anytime at 212-300-5196 for a free, confidential consultation about your case.
Don’t Face Federal Health Care Fraud Charges Alone
If you’re under investigation or have been charged with federal health care fraud, the stakes couldn’t be higher. Your freedom, finances, and professional future are all on the line. This is not something you want to face alone or with inadequate representation.At Spodek Law Group, we have the experience, knowledge, and resources to effectively defend you against these serious charges. We’ll leave no stones unturned in building your defense and fighting for the best possible outcome.Remember – the earlier we can get involved in your case, the more options we’ll have to protect your interests. So don’t wait – contact us today for a free, confidential consultation about your situation. Call us 24/7 at 212-300-5196 or visit our website at https://www.federallawyers.com to schedule your consultation.With Spodek Law Group on your side, you can rest assured that your case is in the best possible hands. Let us put our expertise to work for you and help you navigate this difficult situation. Your future may depend on it.