Have you been accused of committing healthcare fraud? Whether you’re a healthcare provider or patient, the experienced criminal defense lawyers at Suhre & Associates, LLC can help you defend yourself against the allegations. That’s the only way to avoid a conviction, devastating criminal consequences, and serious damage to your reputation.
Our health care fraud defense lawyers have decades of combined experience handling complex matters in federal court. We know that the stakes are incredibly high and that your future is on the line. We’re prepared to roll up our sleeves, fight the prosecution at every turn, and do whatever we can to clear your name.
Do not hesitate to call our law office to arrange a time to sit down with our accomplished and passionate team. Your first consultation is 100 percent free, so reach out to us to schedule yours today.
What is Healthcare Fraud?
Every year, trillions of dollars are spent on healthcare in the United States. In 2018, costs topped $3.6 trillion. Not all healthcare claims are legitimate, though. It’s estimated that, annually, healthcare fraud costs anywhere between $68 billion and $100 billion. That’s roughly 3 to 10 percent of all healthcare expenditures. These costs have a tremendous impact on healthcare – including higher premiums and out of pocket costs.
So, what exactly is healthcare fraud? The crime of healthcare fraud is defined in 18 U.S.C. §1347. You can face federal criminal charges for healthcare fraud if, while acting in connection with delivery or payment of healthcare benefits, knowingly and willfully execute a scheme to:
- Defraud any health care benefit program, OR
- Obtain, by means of fraud or fraudulent pretenses, representations or promises, any money or property owned by or under control of any health care benefit program.
The scheme to defraud doesn’t have to be successful. Any intentional attempt or efforts to defraud a health care benefit program can be enough to warrant federal charges.
Simply put, healthcare fraud means that a doctor or healthcare provider doesn’t submit accurate or legitimate claims to an insurance provider.
Examples of Healthcare Fraud
Healthcare fraud can take a lot of different shapes and forms. While Medicare, Medicaid, and VA fraud are most common, healthcare fraud can also involve private health insurance programs. Here are some examples of what healthcare fraud can look like.
- Doug goes to the Emergency Room after fainting at work. Dr. Stills knows almost immediately, based on Doug’s symptoms and intake information, that he fainted because he was severely dehydrated. However, after seeing that Doug had really good insurance, Dr. Stills ordered several incredibly expensive and highly unnecessary diagnostic tests.
- Dr. Jones treats Sammy for a concussion. He upcodes and bills insurance company for an MRI and a CT Scan, even though neither diagnostic tool was actually used.
- Jan visits her doctor and asks if she can get a botox injection for purely cosmetic purposes. The doctor knows that the insurance company will only pay if the botox is administered for a medical purpose. So, he intentionally uses an improper code when he submits the bill to the provider.
- Eric works as a sales rep for Insurance Company A. After visiting Dr. Sharpe for weeks and showering her with money, services, and goods, he is finally able to convince her to prescribe a drug to her patients that she normally wouldn’t, because it is often unnecessary. This conduct violates federal anti-kickback statutes.
- Dr. Parker improperly and falsely diagnoses many of his patients with appendicitis so that he can perform an unnecessary surgery and bill the insurer.
Note that patients can also defraud a healthcare provider. For example, it would be considered fraud if Mark, who didn’t’ have insurance, took and used his brother’s Medicaid card at the doctor
Penalties For a Healthcare Fraud Conviction
Healthcare fraud costs billions of dollars every year. So, it should be no surprise that the penalties for defrauding a healthcare provider are quite harsh. This white collar crime is a felony. Each count of healthcare fraud is punishable by a maximum of:
- 10 years in federal prison, and
- $250,000 in fines.
The consequences can be more severe if, as a result of a scheme to defraud a healthcare provider, someone suffers serious bodily injury or death. The prison sentence can increase to 20 years or life in prison, respectively.
Healthcare Fraud Has Many Collateral Consequences
Under 18 U.S.C. §1347, healthcare fraud is a crime that’s committed by healthcare providers. When a healthcare provider is convicted of a crime – especially a federal felony offense – the consequences can be catastrophic. In addition to facing harsh criminal penalties – including years behind bars – convicted doctors can also experience many collateral consequences.
A collateral consequence is something that occurs simply because a criminal record exists. These are non-criminal repercussions that can affect a person’s life for years. In fact, these social and civil penalties can potentially remain in place as long as a criminal record exists. So, there’s a potential these consequences could last for a lifetime.
A doctor or healthcare professional convicted of healthcare fraud might experience collateral consequences such as:
- The loss of professional licenses or accreditations, which can result in a need to change careers
- Job loss
- Difficulty securing financial assistance or loans
- Inability to hold public office
- The loss of the right to own a firearm, and
- Inability to enlist in the military.
Fraud is a crime that involves deception and dishonesty. In turn, a conviction can do incredible damage to a doctor’s reputation. That’s quite a serious consequence, all on its own.
Defending Allegations of Healthcare Fraud
If you’ve been accused of committing healthcare fraud, you can be certain that the federal government will do everything in its power to convict. However, before that can happen, prosecutors will have to:
- Convince a grand jury that there is probable cause to support the charges, AND
- Convince a judge or jury that you are guilty of healthcare fraud beyond a reasonable doubt.
If a grand jury doesn’t indict, you won’t be charged. If the prosecution can’t satisfy the burden of proof in its criminal case, you can’t be convicted.
While the government works toward these goals, you will have the opportunity to defend yourself. A smart, dynamic, aggressive defense can make a massive difference in the path your criminal health care fraud case takes. The best course of action is to hire an experienced criminal defense lawyer to take the lead.
At Suhre & Associates, LLC, our legal team has decades of combined experience handling complex federal matters, including healthcare fraud. When you call us for help, we will rely on our experience and in-depth knowledge of federal law and procedure as we build your defense.
We’ll begin with a thorough independent investigation into your alleged offense. Whenever necessary, our attorneys will enlist the help of experts so that we’re working with the best possible information. We’ll gather evidence and comb through whatever the government provides during the discovery phase, searching for anything to help bolster your defense. We’ll raise any legitimate defense on your behalf. That could include:
- You didn’t act with the required intent, meaning your actions weren’t knowing or willful
- You made a mistake
- You’ve been falsely accused
- You did not make any false claims, or
- Your rights have been infringed or violated.
A successful defense strategy doesn’t just involve raising arguments that excuse, explain, or justify your alleged behavior. Rather, it involves challenging the government at every turn. Attacking evidence. Finding ways to discredit witnesses. Identifying where the prosecutions’ case is weakest and using those points as leverage. If the government can’t satisfy its burden of proof, it can’t win. End of story.
Contact Our Federal Health Care Fraud Lawyers Today
Healthcare fraud is a serious crime. If you’ve been accused, indicted, or charged with this federal offense, reach out to Suhre & Associates, LLC for assistance. Our healthcare fraud attorneys are prepared to help you fight to clear your name and win your healthcare fraud case. We’ll invest whatever time, manpower, and resources are necessary to help you protect your future.
We know that this might be a very overwhelming time. You probably have a lot of questions. That’s why our law firm offers a free consultation. This way, you can sit down with one of our experienced attorneys, explain your side of the story, and get some preliminary legal advice and assistance. We’ll do our best to explain your legal rights and address any concerns you may have. It’s important to get started on your defense as soon as possible, so call now.