National Healthcare Fraud Lawyer Protecting Your Rights
Healthcare billing can be incredibly complex, and mistakes do happen. So, it can be premature to believe that any issue relating to discrepancies in healthcare expenses and insurance coverage is the result of fraud. In many cases, investigations must take place in order to determine whether a simple error was committed or if the actions of a patient, doctor, insurance, or supplier were fraudulent in nature.
Accusations of healthcare fraud come from everywhere — the patients, their physicians, the federal government, and so on — and even if there was no criminal wrongdoing, these accusations leave a lasting negative stain on the reputation of healthcare providers. The government, especially, has begun to direct its ire at those involved in the health industry, accusing many of committing fraud. The Department of Health and Human Services (DHHS) and the Drug Enforcement Agency (DEA) are on the lookout for any perceived legal issue by which they can accuse a healthcare provider of criminal offenses and file federal charges.
If you, your family, or your business are facing healthcare fraud charges, it is important that you seek legal advice from a defense firm with exceptional knowledge in representing those accused of breaking federal law in the healthcare industry. Whether you are guilty or are a victim of a false claim, it is important that you understand that federal prosecutors and the inspector general will pursue the harshest consequences allowed under the law.
Diane C. Bass is one of the most highly respected fraud defense attorneys in Southern California and nationwide. She is well-reviewed by both her clients and her fellow defense lawyers as an attorney who gives each case dedicated personal attention and tries to provide the best defense in pursuit of a winning outcome or plea bargain for her clients. Like other respective law firms, the lawyer’s legal team is bound by a confidential attorney-client relationship, meaning a new client should feel safe confiding the truth of their case with the Law Office of Diane C. Bass firm. Representing clients across Orange County and other jurisdictions in Southern California, Diane C. Bass offers new clients a free consultation where they may go over the particulars of their healthcare fraud case.
What Are Different Types of Healthcare Fraud?
Few industries in America are targeted more by federal law and new language for federal offenses than the healthcare industry. While it is true that some misconduct and fraud do occur as the result of the actions of healthcare providers, many times, there are simple misunderstandings and minor errors in paperwork and billing expenses.
Examples of healthcare fraud include:
- Anti-kickback statute violations, such as accepting money unlawfully.
- Billing fraud, including billing someone who is not a patient, billing for hours where no services were performed, billing for services or devices that were not necessary, or billing more than once for the same service or device.
- Department of labor fraud.
- Falsifying doctor credentials.
- Falsifying health care reports.
- Falsifying patient records.
- Forging doctor’s orders or prescriptions.
- Illegally sharing fees.
- Medicaid fraud.
- Medicare fraud.
- Ordering medication without doctor approval.
- Patient received medical service they were not qualified for or was deemed unnecessary.
- Prescribing medicine illegally and unethically.
- Providing unnecessary medical services, medicines, or supplies.
- Selling illegal or fake medicines.
- Stark law violations (physician self-referral).
- Stealing medicine or health care supplies.
- Violating the controlled substances act.
If doctors or other health care providers are illegally selling prescriptions, they can face harsh penalties under the law. Patients or doctors can attempt to bill insurance companies for services that they do not cover or allow, which can result in conflict or accusations. Hospitals sometimes purchase medical supplies which are not needed for their patients and bill them to an insurance healthcare benefit program while never actually providing those supplies. Other times a healthcare benefit program may be billed for services that were never actually rendered for the patients at the physician’s office.
Many healthcare fraud charges are filed as conspiracies, as they typically require the planning and cooperation of multiple individuals to see the scheme to fruition. Healthcare fraud charges may be linked to other types of fraud, too, like wire fraud or mail fraud, and white-collar crimes like money laundering.
What Are Examples of Medicaid and Medicare Fraud?
If you or your physicians’ office have been accused of Medicare fraud, your practice could face lasting consequences. Even if you prove the accusation false or the result of some mistake, the lasting damage such a charge has on health care providers can be absolute.
Government-run healthcare programs cost the American taxpayers a lot of money each year. So, the US government takes any accusations of those attempting to defraud Medicare and other similar programs very seriously.
Examples of Medicare fraud include:
- Billing twice. Double billing occurs when a doctor or clinic bills their patient, the insurance provider, or Medicare program more than once for the same treatment, med, or supply.
- False claims about cost. Numerous doctors have been accused of billing for hours not worked or meddling with the billed cost of their care on expense reports.
- Illegal self-referrals. Health care physicians are not legally permitted to issue a referral to any professional or service in which they have a financial interest. The government considers this fraud.
- Patient record falsification. Sometimes a doctor will bill Medicare for care that was unnecessary, justifying it by ‘doctoring’ the medical records to make it seem as though the patient needed that service. In some cases, a doctor or clinic has prescribed meds or provided services to a patient, doing more harm than good in an attempt to secure a kickback.
- Phantom billing. When physicians bill Medicare for a medical procedure or service which was never actually performed, it is sometimes dubbed ‘phantom billing.’ These are the most common Medicare fraud charges. However, they are often the result of a misunderstanding, for example, neglectfully billing a patient who has passed away or moved to another city or state.
- There can be a discounted payment for services that are billed together. When ‘unbundled’, the services are fraudulently billed separately, resulting in a higher payout from Medicare.
- A health care professional may feel tempted to code the service they provided as something more expensive than what it really was in order to obtain money from healthcare programs and may be found guilty of Medicare fraud.
- Violating the anti-kickback statute. It is illegal for physicians to have an agreement with any pharmaceutical company, insurance, medical supply provider, or health care organization that sees them reap a reward for prescribing care with the expectation of receiving a financial kickback. The federal anti-kickback statute strictly prohibits bribes between company suppliers and doctors. Similarly, a laboratory cannot charge a commission for every patient they perform tests or blood work for. Otherwise, more such tests would be demanded in order to drive up business.
If you’ve been accused of defrauding a patient, provider, insurance company, or any government healthcare program, it is vitally important that you seek a law firm with experience defending against these types of charges. Though Medicare may be a federal program, state laws may differ from national laws, so it is important that you find local counsel familiar with national rules and regulations.
As your defense attorney, Diane C. Bass will offer her years of experience to provide legal advice so that you feel involved with your fraud defense going forward. If you have been accused of making false claims or other federal offenses amounting to Medicare fraud, please contact the Law Office of Diane C. Bass to schedule a free case evaluation.
How Do Federal Government Agencies Prosecute Health Care Fraud?
If a federal offense exists, then there is probably a federal task force that performs investigations with the express purpose of detecting those offenses and filing fraud charges accordingly. If any such task force has set its eyes on you, suspecting the potential of healthcare fraud, then you must speak with defense lawyers experienced with fraud defense immediately. Orange County defense lawyer Diane C. Bass is experienced with taking on federal prosecutors in fraud cases and other types of white-collar crimes.
The many different federal government organizations which are involved in the investigations into fraud against the healthcare industry include:
- Department of Justice (DOJ)
- Medicaid Fraud Control Units (MFCUs)
- State Medicaid Agencies
- The Center for Medicare and Medicaid Services (CMS)
- The Department for Health and Human Services (HHS)
- The Federal Bureau of Investigation (FBI)
- The General Services Administration (GSA)
- The Health Care Fraud Prevention and Enforcement Action Team (HEAT)
- The Office of Inspector General (OIG)
Federal prosecutors must prove certain elements of fraud in a court of law in order to secure a guilty verdict. They must show that the defendant intentionally and knowingly sought to defraud other parties in their scheme. They must show that the defendants knowingly spoke falsely, omitted facts, or misrepresented relevant information in order to financially benefit from fraud in the service of, or in relation to, health care in America.
What Federal Statutes Do Investigations Adhere to in Health Care Fraud Cases?
There are various statutes and rules which grant the government power and authority in cases of healthcare fraud in hopes that healthcare providers maintain certain professional conduct. The laws are at the core of most healthcare fraud investigations.
- The Anti-Kickback Statute. Financially benefiting by some arrangement with a pharma company or other medical supplier is against the law. The Anti-Kickback Statute applies to both criminal and civil healthcare fraud cases. In a country that encourages business success and innovation, sometimes the line between lawful and unlawful conduct can begin to blur. Your defense attorney will attempt to show that you entered into any partnership in good faith only.
- The Civil Monetary Penalties Law. The Secretary of HHS can apply additional fines to those found guilty of Medicare fraud.
- The Controlled Substances Act. Used against health care professionals guilty of committing pharmaceutical fraud and other crimes relating to medicinal drugs, the Controlled Substances Act (CSA) establishes a set of rules which every practitioner must abide by.
- The Criminal Health Care Fraud Statute. Sometimes known as the Federal Health Care Fraud Statute, this law establishes that it is a crime to knowingly seek to defraud any healthcare benefits program. The perimeters of the statute are extremely broad. If federal prosecutors can determine that fraudulent acts have taken place, you may be in violation of the healthcare fraud statute.
- The False Claims Act. A health care professional knowingly or unknowingly making a false claim to Medicare or any other healthcare organization may run afoul of the False Claims Act. Investigations may determine whether the accused should form a civil or criminal defense for violations of the False Claims Act.
- The Stark Law. Violations of the Stark Law are when doctors and physicians are guilty of “self-referral.” The law was established, in part, to place regulations on the way in which doctors work in collaboration with labs for tests. The Stark Law could be likened to insider trading within the healthcare field.
- The violation of billing regulations. Unlike typical fraud cases, the intent is unimportant here. If you are in violation of strict billing regulations, you can be charged with a criminal offense. An audit may determine if any regulation has been violated. Sometimes these violations occur by accident, as billing regulations change fairly often.
- And the violation of new DOJ mandates. DOJ mandates may not be written law, but they do establish the focus and intent of the federal government. DOJ mandates may tip off where prosecutors are most focused at any given time.
What Are the Consequences of a Guilty Verdict for Healthcare Fraud?
The consequences for conviction of healthcare fraud differ and are largely dependent on the particulars of any given case. Additionally, the part that the individual had to play in any fraudulent scheme may determine the severity of their sentencing. For example, those who had a minor part to play may see lighter sentencing than the conspiracy’s masterminds.
In addition to being forced to pay off hefty fines, those found guilty of healthcare fraud may also receive sentences that permanently damage their ability to provide services in the healthcare field. Physicians may lose their medical licenses in some cases.
Because a charge of healthcare fraud often comes with other criminal charges, it is possible that additional charges could result in enhanced sentencing. If you are suspected of fraud, please speak to a local counsel who is aware of national laws relevant to your case.
What Are the Legal Options for a Winning Fraud Defense?
It is important that every charge or suspicion of healthcare fraud be treated seriously. Even if you did not act to defraud anyone, mere accusations could have lasting damage to a health care professional’s legacy. Some may think that they can explain away any misunderstanding. However, it is still important that you seek local counsel at a law firm experienced in fraud defense.
Fraud defense attorneys may be able to help establish that you acted only in good faith. While the prosecution often has to prove criminal intent, your defense lawyer needs to only provide reasonable doubt. And if the firm is unable to provide this outcome, they may be able to help draft useful plea bargains so that you avoid the worst consequences in court.
Defense attorney Diane C. Bass has extensive experience providing clients in California and nationwide with knowledgeable, winning defenses. If you have been accused of healthcare fraud or are charged with violating the False Claims Act, please contact the firm of Diane C. Bass to schedule a confidential consultation.
Contact the Law Office of Diane C. Bass to Build Your Fraud Defense
Many examples of fraud come from unfortunate mistakes and technical errors. Healthcare is a complex American industry with constantly changing regulations, and it can be difficult to keep up with all the updated rules and laws. If you have been accused of fraud, falsely or not, you need to speak with local counsel experienced with representing clients in these types of civil and criminal cases. The Law Office of Diane C. Bass is a highly respected firm in and around Orange County, CA, known for its dedication to its clients in high-profile criminal cases.
If you have been accused of healthcare fraud against a hospital, physician, healthcare benefit program, Medicaid, or Medicare, then it is vitally important that you begin to craft your fraud defense as soon as possible. These charges are serious and can result in extreme fines or the loss of your medical practice if you are found guilty.
The first step to a strong defense is putting your trust in the hands of an experienced lawyer under the attorney-client relationship. To schedule a free consultation with attorney Diane C. Bass, please call 949-494-7011.