Healthcare Fraud

< DC White Collar Criminal Defense

DC Healthcare Fraud Attorneys

Billions of dollars are lost annually due to health care fraud, including Medicare and Medicaid fraud, resulting in significant financial and economic consequences for insured individuals, taxpayers, and the U.S. economy. Convictions for such offenses carry heavy fines and imprisonment. In cases of federal health care fraud, it is crucial to consult a DC federal health care fraud lawyer to understand the potential implications in federal court.

When allegations of health care fraud are reported by whistleblowers or when suspicious claims require investigation, various government agencies, such as the FBI, US Secret Service, OIG, and USPS, among others, are responsible for probing and uncovering fraud in federal and private health care insurance. Health care fraud falls within the purview of federal white-collar crimes, and cases are prosecuted in the US District Court, located in the E. Barrett Prettyman Courthouse at 333 Constitution Avenue NW in DC. Only a federal criminal defense attorney licensed to practice in federal court can represent clients facing these serious charges.

Defining Healthcare Fraud

Health care fraud encompasses a range of activities where benefits meant for legitimate medical services are misused through fraudulent or falsified information. Fraud can involve individuals, medical groups, and may be a one-time incident or part of an elaborate scheme. A DC federal health care fraud lawyer will investigate the specific circumstances of a case and explain how the following health care fraud schemes might apply:

Fraud involving medical practitioners may include:

  • Billing for services not rendered
  • Filing duplicate claims
  • False coding of medical procedures
  • Falsifying date/description of services
  • Falsifying medical records
  • Prescribing unnecessary treatments or procedures
  • Acquiring unnecessary subsidized or covered prescription drugs for profit
  • Accepting/providing kickbacks for patient referrals
  • Health care and insurance policy carriers or members can commit fraud through actions such as:
  • Forging prescriptions
  • Selling prescription drugs
  • Using another person’s insurance card and information
  • Using medical benefits for non-medical purposes
  • Falsifying personal information when applying for benefits
  • If suspicious activity is detected, an immediate investigation or inquiry may ensue. If an individual becomes the subject of a health care fraud investigation, seeking legal counsel promptly is crucial. A DC federal health care fraud defense attorney can advise clients of their rights and help them avoid self-incrimination throughout the investigative and interrogative processes

Medical Identity Theft

According to the NHCAA, up to half a million people fall victim to medical identity theft, leading to personal medical information being intermingled with someone else’s medical history. Perpetrators of medical identity theft use another person’s medical and insurance information to receive treatment while keeping their own medical record clean. Lost insurance cards, discarded explanation of benefits (EOB) forms, or intercepted medical bills are common ways unsuspecting individuals become victims of medical identity theft.

Healthcare Fraud Penalties

Under 18 US Code Section 1347, successful execution or deliberate attempts to defraud any health care benefit program or gain money or property illicitly through such programs are penalized. A health care fraud offense typically carries a maximum of 10 years in prison and substantial fines.

In cases where fraud leads to serious bodily injury, risking death, extreme physical pain, visible disfigurement, or the loss or impaired function of an organ, mental capacity, or body member, the term of imprisonment increases to a maximum of 20 years.

If a health care fraud offense results in someone’s death, the maximum penalty upon conviction is a life sentence in prison. Given these severe consequences, consulting with a DC federal health care fraud lawyer is crucial when making important decisions regarding a case.

Initial Steps for Lawyers

When presented with a health care fraud case, lawyers first examine government documents, such as affidavits supporting search or arrest warrants. Reviewing documents produced by the government or law enforcement is essential. Lawyers then discuss these documents with their clients to gather additional information before commencing their own investigation.

Criteria for Choosing Representation

When choosing an attorney, clients should consider hard work and knowledge as essential qualities. Success in a health care fraud case is directly tied to the time invested, including information gathering, examination of legal issues, and thorough investigation. During trial preparation, the attorney plays a crucial role. Considering the technical nature of health care fraud cases, it is vital to select an attorney experienced in handling these complex issues and who has prior experience with health care fraud cases.

Contacting a Healthcare Fraud Attorney

The FBI estimates that up to 10% of all health care expenditures result from fraudulent billing to private and public health care programs. As health care fraud becomes more prevalent as a form of organized crime, federal agencies are taking action. Those accused of health care fraud face prosecution seeking maximum penalties. A federal health care fraud defense attorney can challenge prosecutors and help clients achieve the best possible outcome.