State or federal prosecutors and law enforcement agents targeted you and your practice for suspected criminal violations . . . what do you do, who do you call? This and similar questions are asked every day by health care providers in the midst of the largest federal and state crackdown on potential criminal violations. Health care fraud costs taxpayers billions of dollars annually. Therefore, the discovery and eradication of health care fraud in all of its forms is fast becoming a huge federal and state enterprise with hundreds of millions of dollars being devoted to this effort.
Unfortunately the innocent physician and/or health care provider is being targeted. Thousands of unsuspecting and innocent health care providers are being forced to defend their actions or face stiff criminal penalties. Some of these investigations are unfair, overzealous, and callously approached by state and federal officials. Imagine having a team of U.S. Attorneys, federal agents and regulators, who specialize in health care fraud, raid your practice on any given Monday taking all of your health care records, computers, etc. and basically telling you you’re out of business! What do you do, how do you do it, and what are your rights?
The first reaction is to call the best criminal defense attorney you can find. This is not bad advice; however, we would like to pose a different approach. Call an attorney who is skilled in health care law and let him/her direct and guide your team. Unlike most other areas of criminal defense, health care fraud is investigated and prosecuted by agents who specialize in health care fraud and attorneys who specialize in prosecuting health care fraud. When defending allegations of health care fraud or drug trafficking, you need a criminal defense attorney who specializes in health care fraud.
A health care attorney is generally more familiar with the legal arsenal state and federal prosecutors have at their disposal. Additionally, the underlying facts necessary to prove their allegations or prove your defense are strictly speaking medical, and not criminal, in nature. Things like Medicare Conditions of Participations, Medicare Conditions of Payment, whether a specific DRG code was medically necessary or justified, and similar questions are all health care related and often the criminal attorney is at a loss of what to do and how to do. The consequence, a bad settlement! Don’t settle your criminal allegations because of ignorance or lack of knowledge or lack of a proper defense.
Additionally, the licensing ramifications of settling any criminal allegation can be devastating and far worse than the criminal penalty. Imagine settling a very small alleged fraud case, say $1,000, for no probation and a slap on the wrist. Sounds good, until 6 months later when you receive a letter from the OIG stating you are being placed on the Exclusion list, followed by letters from all states in which you are licensed that licenses are being investigated or revoked. Sounds impossible? No, it sounds likely, if you make the wrong move at the wrong time. A skilled health care law attorney will know what to do and when to do it and be able to set forth all of your options. Chapman Law Group has offices in Michigan and Florida and consults on cases nationwide. We know what to do, when to do it, how to do it, and when to call in additional team members to ensure a proper defense. When you’re fighting the government, make sure your team has the skills, knowledge and ability to win.
Below is a table of some of the more popular criminal charges. Look at the elements of each civil or criminal allegation. All of the elements relate to the intricacies of health care management, payment, record keeping, etc. Remember, you most likely got in this position because you made a mistake in billing, accepting a referral fee, entering into an improper contract, etc. If you, as a skilled health care provider made a billing mistake, do you really think a criminal attorney is going to know the intricacies of how to defend you? Yes, bringing on a health care law attorney may be more expensive, but look at the time and effort and money spent on obtaining your medical degree, consider the loss of income or changing careers at 50+, and then make your decision wisely.
Comparison of Health Care Fraud Statutes and Penalties (click on chart below to enlarge)
18 USC §371 – Conspiracy to defraud the United States
18 USC §1956 – Money Laundering
21 USC §841 – Drug Trafficking
42 USC §1320a-7b(a) – Social Security Act, false statements prohibition, illegal patient retention & admission
18 USC §§ 1341 and 1343 – Mail and Wire Fraud
42 USC § 1347 – Health Care Fraud
18 USC § 669 – Theft or Embezzlement in relation to hHealth care
42 USC § 1035 – False Statement, covering up by trick, scheme or device a material fact…
Please consider Chapman Law Group. Our team of experienced health care law attorneys will assist you in preparing the best possible defense and will assemble the proper team to address the criminal and/or civil charges, giving you the best chance possible. Remember, the federal government has the largest criminal defense team in the world, they are good, and they are eager to build their resumes with convictions of physicians who arguably broke the public trust. Don’t be afraid of them, but put together the best team possible!
Chapman Law Group (CLG) is a professional health care law litigation firm, with offices in Michigan and Florida (Sarasota & Miami). For over 25 years CLG has defended the rights of health care professionals, providers and corporations involved in the delivery of health care at all levels. CLG handles claims involving false claims, anti-kickback, Stark, civil monetary penalty, DEA controlled substance act violations, compliance related issues including Medicare, Medicaid and private pay, OIG investigations, audits of all types, professional licensing, state and federal criminal charges, civil and administrative actions, peer review and credentialing issues, HIPAA compliance, and much more involving health care professionals. We believe the dedicated men and women who provide health care deserve an exceptional defense when their integrity and actions are called into question.
Ronald W. Chapman, MPA, JD is the founder and shareholder of CLG. For 30 years Ron has focused his practice in the defense of health care providers of all levels of health care including medical malpractice defense, compliance issues, fraud, criminal and civil defense, peer review and credentialing issues, correctional health care law, civil rights law, and all types of health care administrative law matters at the state and federal level in Michigan and Florida. Ron is currently completing his LLM in health care law at Loyola Chicago College of Law.