Criminal Healthcare Defense

Health care Fraud Defense

The federal government is waging a war on healthcare fraud. The Office of Inspector General, the Department of Justice and the FBI are teaming up to investigate and prosecute healthcare fraud and have the resources of the federal government at their disposal. As the government becomes more aggressive and creative in these prosecutions, the defense against criminal healthcare fraud allegations has become more complicated and specialized. Anyone who has attempted to read the healthcare laws and regulations knows that the language is sometimes vague and leaves much to interpretation. If you choose a lawyer that is not specialized in health care fraud defense, you can run the risk of a criminal defense that lacks the creativity and knowledge that a healthcare law attorney can provide.

Health Care Fraud not only carries civil penalties, but also criminal penalties. These penalties can include large fines and jail time. In addition, criminal convictions can cause a medical provider’s license to be suspended or terminated. See here for more about health care fraud.

When choosing an attorney to defend against criminal healthcare fraud charges, you should choose an attorney that is experienced in health care law in addition to criminal defense.  Health care regulations are unique and intricate. When your practice, your financial resources and your freedom are at stake, it is vital to choose an attorney that understands the language of the healthcare laws and regulations. When hiring a criminal defense attorney, you should choose a professional that can stand in your shoes and explain your position as you would.  Only a criminal defense attorney that specializes in health care fraud and laws can understand the plight of medical providers and the difficulty they face in the highly regulated medical industry.

False Claims

As the realm in which False Claim and False Statement allegations expands to include standard of care, conditions of payment and conditions of participation, the defense of these allegations proves more difficult. Traditional criminal defense attorneys may not possess the knowledge and experience required to drill down to the root of the allegations and to explain the intention of the healthcare provider. The concept of Standard of Care can be vague and left to interpretation. What constitutes the correct Standard of Care may vary from medical provider to medical provider.  The difference between not providing a service and providing exceptional service may seem obvious but what about the levels of care in between? Standard of care is the level of care at which the average, prudent medical provider or healthcare entity in a community would practice. It is how similar practitioners and facilities would have managed the patient’s care under similar circumstances. This definition leaves much to interpretation. Who is an average, prudent provider? How is “community” defined? What is a “similar circumstance”? The correct level of care or treatment varies among medical providers and changes over time. It can be affected by resources and innovation. Violations of Standard of Care can be the basis for a False Claim or False Statement allegations. Experienced health care law defense attorneys must be able to understand the law that applies in addition to understanding how the medical industry operates and how medical care is delivered to patients.

Many times, the delivery of healthcare is a collective effort on behalf of several if not many providers. Medical providers are essentially building blocks that work together to provide the complete health care of a patient. Some medical services require a prescription or referral from another medical provider in order to show medical necessity. During health care fraud investigations, federal agents can probe in to the different levels and layers of a patient’s care. It is possible that criminal charges can be waged against several individual medical providers during the same investigation. In order to provide quality defense against criminal health care fraud charges, it is imperative that the health law attorney understand how medical care is delivered. An experienced health care defense lawyer must be able to untangle the individual providers in a patient’s care and understand the dynamics of how they all fit together. Sometimes services that are considered “medically necessary” by one medical provider, may not be considered medically necessary to another. Discretion is an important part of being a treating provider. An experienced health care law defense attorney can help medical providers craft a criminal defense that is grounded in medical theory and practice.

Sometimes, False Claim and False Statement allegations can be based on specific medical coding used in billing the federal healthcare program. Without knowledge of CPT and ICD9/ICD10 coding guidelines, a criminal defense attorney cannot provide the highest level of quality representation needed to defend against healthcare fraud charges. Sometimes routinely upcoding certain procedures or not correctly bundling charges can lead to a false claim. The difference between one CPT and another can be obvious on the surface but in reality may not be so exact. Criminal violations normally require an intention to defraud. This intention can be found in knowingly committing fraud or reckless disregard for the truth. With the many levels of health care delivery from patient care to billing to referral among providers, there is much room for miscommunication and error. Just as medical practice is not an exact science; the billing of medical service is not always exact.  Traditional criminal defense attorneys may not possess the understanding for this process. Criminal defense attorneys that specialize in health care fraud can make the difference between a sound defense and one that is lacking in detail and foundation. A traditional criminal defense attorney may never have seen a claim form or an EOB. They may not know what an LCD (Local Coverage Determination) or MLN Matters contain. The medical field is a vast industry encompassing many specialties, opinions and theories. Choosing representation for defense against criminal health care fraud allegations may be the difference of continuing to practice medicine and having your license revoked or spending time in jail. See here for more about false claims.

Criminal Charges and Its Impact on Medical Licensure

Another important consideration for a medical provider charged with criminal health care fraud is the implication to the provider’s medical license. Many times, pleading guilty to criminal offenses, even lesser offenses, can lead to the termination or suspension of a provider’s medical license. This can be true even if the criminal offense is not healthcare related. Traditional criminal attorneys may not realize this implication and may cause more harm than good. Once a plea is entered, it is very difficult to have it removed. Traditional criminal attorneys may be focused only on the criminal charges and may not look beyond those implications. Criminal attorneys that specialize in health care law have experience dealing in the administrative realm of medical licensure. The existence and continuation of a medical license is decided by the Department of Health. This administrative process is separate from the criminal defense and requires unique experience dealing with the agency.

Hiring a criminal defense attorney that specializes in health care law will place the medical provider in the best position to protect the continued livelihood of the provider’s practice.  Considerable work, time and effort go in to obtaining a medical license.  Medical providers owe it to themselves to do everything in their power to protect what they have worked so hard to achieve.

Our Experience

Our team of attorneys includes two former government prosecutors, one of which was previously Deputy Attorney General for Idaho’s Medicaid Fraud Control Unit and Special Assistant United States Attorney. Attorney Perkovic’s previously investigated and prosecuted health care fraud on behalf of the government. She now uses her many years of experience to defend providers. Attorney Ronald W. Chapman is a former federal (military) prosecutor and public defender. Since joining the firm, he has successfully defended dozens of providers nationwide who have been accused of health care fraud and drug trafficking. Attorney Chapman frequently presents and publishes on topics related to prescribing practices, DEA issues and criminal issues affecting providers.

Our team also includes two attorneys that are highly educated in the area of health care law. Attorneys Chapman and Santos have earned master of laws degrees in health care law. Their extensive knowledge of all areas of heath care law, including fraud, makes them excellent in the areas of health care compliance. Both attorneys work with individuals and corporations within the health care industry to help ensure that all aspects of their practice comply with the many federal and state laws that regulate health care. All of our attorneys are dedicated to, and highly experienced, in various areas of health care law. We handle cases from the most complex health care fraud cases, to compliance review and representation during audits.


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