Criminal Defense

Physicians, nurses, psychiatrists, chiropractors, physical therapists, acupuncturists, athletic trainers, dentists, nursing home administrators, social workers and other health professionals licensed in the State of Michigan need a criminal attorney who appreciates the collateral consequences of a criminal conviction. When charged with a crime, health professionals must defend their actions in both criminal court and before the state licensing board for their respective profession. There are two distinct areas of law that are applied during these proceedings; the relevant state Penal Code and the Public Health Code.

Many attorneys who only practice criminal law are not aware of the intricacies of the Public Health Code and the requirements imposed on licensed health professionals. Choosing a criminal defense attorney who is not familiar with professional licensing may be a costly mistake. Often clients end up with two attorneys; a criminal attorney and a professional licensing attorney. Health professionals are better served by selecting an attorney who is experienced in both professional licensing and criminal law.

Our Experienced Health Law and Criminal Defense Attorneys Have Worked With Health Professionals for Over 25 Years

Chapman Law Group offers comprehensive representation of health professionals during criminal proceedings and any resulting professional licensing or administrative action. Our criminal defense attorneys are dedicated to the defense of medical professionals and other licensed professionals. We provide aggressive legal representation for physicians, nurses and others who face criminal prosecution. Our goal is to not only streamline this process, but to ensure that the criminal conviction is handled in such a way as to limit the impact on the client’s professional license.

Sadly, criminal defense attorneys who do not practice administrative law often plead criminal cases in such a way that it makes it difficult to avoid licensing action from the state and the professional’s licensing board. From the onset of your representation, we consider the licensing ramification when developing a strategy and we aggressively represent you during criminal and administrative proceedings.

Our Criminal Defense Attorneys Know the Medicine

Additionally, our criminal/professional licensing attorneys know the medicine. At Chapman Law Group, we not only have attorneys with over twenty (20) years of experience representing health professionals, we have attorneys who are licensed nurses and physicians. Our attorneys know the intricacies of your profession and the law.

When facing criminal charges Chapman Law Group attorneys will represent you. We combine standard of care knowledge with criminal law experience to provide a comprehensive defense. Regardless of the criminal charges, healthcare fraud, diversion, trafficking, unlicensed practice of medicine, or any other health related charges we are ready to help!

Additionally, in over twenty (20+) plus years of practice in health law, we assembled an experienced team of experts in nearly every area of medicine. If charged with a particularly complex offense requiring an expert opinion or consultation, we can put our experts to work for you in order to provide the fact finder with a reliable expert opinion.

Chapman Law Group understands the unique and rigorous requirements imposed on health professionals. When you retain Chapman Law Group, you retain a team of skilled professional licensing and criminal attorneys who know how to navigate the difficult waters of criminal courts and administrative boards in order to achieve the best possible result.

Criminal Charges Almost Always Result In Licensing Investigations

If served with a Criminal Complaint or Federal Indictment for Medicare/Medicaid fraud, drug diversion, criminal negligence, health care fraud, or if you have been arrested for DUI, DWI, OUIL, disorderly conduct, shoplifting, assault, or any other felony or misdemeanor, you can anticipate that the Department of Health or the Department of Licensing and Regulatory Affairs will investigate whether or not you have violated the Public Health Code. It is imperative that you retain an attorney to immediately defend your freedom during the criminal case and also protect your livelihood during the licensing proceedings.

More information about criminal allegations and their impact on professional licenses

In The Event Of A Felony or Misdemeanor Conviction, You May Face Summary/Emergency Suspension

If you are facing felony or misdemeanor charges related to alcohol or substance abuse, you may even be subject to a Summary Suspension or Emergency Suspension which immediately prevents you from practicing. In the event of a felony conviction, your license will likely be summarily suspended. If you receive an alcohol-related misdemeanor conviction, you may also face a summary suspension. If you are facing felony or misdemeanor charges, it is imperative that you seek the advice of an attorney who can navigate the criminal and administrative courts and get you the best possible result to protect your freedom and livelihood.

More information about Summary Suspensions and Emergency Suspensions

Pleading Guilty Has Serious Consequences in Administrative Proceedings

A guilty plea is the strongest form of proof under the law. When you plead guilty to a criminal offense, you are prevented from later arguing differently in an administrative proceeding. Before accepting an offer or entering a guilty plea, it is imperative that you are advised on the collateral consequences of your plea of guilty and its effect on your professional license. In most states mandatory suspension of a health professional’s license is required following a felony conviction and certain high misdemeanors. The suspension may be overturned at an administrative hearing; however, you will need an attorney experienced at representing licensees during suspension hearings. All too often, criminal attorneys do not appreciate the consequences of a guilty plea and clients are forced to accept a less than desirable outcome at an administrative proceeding. Additionally, an experienced licensing attorney can advise you on which misdemeanor pleas are less likely to result in suspension of your license.

Click here for a list of collateral consequences for licensed professionals

Reporting a Criminal Conviction Should Be Done By a Skilled Professional Licensing Attorney

According to MCL 333.16222(3), a licensed health care professional is required to report a criminal conviction to the Michigan Department of Licensing and Regulatory Affairs within thirty (30) days of the conviction. Under Florida Statutes, Chapter 456, all licensed health professionals are required to report convictions (guilty, nolo contendere, differed prosecution) within 30 days. If the licensing board believes that your criminal conviction has the potential to affect your ability to practice your profession, they may impose sanctions up to and including license revocation. Therefore, it is imperative that your report of conviction puts you in the best light possible and shows the board that you can still safely and skillfully practice your profession. It is imperative that, immediately after your arrest, you contact a skilled professional licensing attorney so that you can begin the steps necessary to mitigate the consequences and seek treatment, if necessary. Aggressive representation at the outset will improve your chances of receiving a more favorable result in both criminal court and before your respective board.

More information about reporting criminal convictions to the Board

You Need an Experienced Attorney Who Knows Your Profession, Knows the Medicine, and Knows the Law

Your unique position as a healthcare professional requires that you retain an attorney with a proven track record to protect your freedom and livelihood. Don’t make the mistake of selecting an attorney who is unable to represent your interests during criminal proceedings and administrative proceedings, or an attorney who is ill equipped to advise you on the collateral consequences of your plea or conviction in criminal court. You need an experienced attorney who knows your profession, knows the medicine, and is equipped with the knowledge to provide you with complete comprehensive representation in both arenas. Put the time tested experience of an established health law firm to work for you today. Call Chapman Law Group at (248) 644-6326 for a free consultation with one of our criminal/professional licensing attorneys today.

Criminal Defense Health Care Fraud and Prescription Fraud

The Drug Enforcement Administration (DEA) continues to aggressively investigate and pursue criminal charges and licensing sanctions against physicians, pharmacists, and other licensed health care providers for health care fraud. Well-meaning practitioners who step outside of the myriad of DEA and Center for Medicare & Medicaid Services (CMS) regulations may find themselves facing criminal charges for violation of 18 U.S.C. §1347 (and other statutes), suspension of their DEA license, and state licensing sanctions; including revocation of their license by the Pharmacist Board, Medical Board, Board of Osteopathic Medicine, or other respective Michigan Licensing Board.

“Defense of your complex Health Care Fraud case requires more than an attorney specializing in criminal law.”

If you are facing investigation or charges related to Health Care Fraud, it is vitally important that you select an attorney not just competent in criminal law matters, but competent in the range of civil, criminal, and administrative issues involved in complex health fraud cases. Our experienced health care fraud attorneys provide comprehensive representation for all of your administrative, civil, and criminal needs so that you can rest assured that you have the benefit of experienced and knowledgeable counsel in all areas of health law.

“What constitutes Health Care Fraud?”

Health care fraud occurs when an individual, a group of people, or a company knowingly misrepresents or misstates something about the type, scope, or nature of the medical treatment or service provided, in a manner that could result in unauthorized payments being made. There are many reasons that a practitioner can be investigated or charged with health care fraud such as:

  • Falsifying certificates of medical necessity;
  • False, fraudulent, or duplicate billing;
  • Billing for non-covered service as a covered service;
  • Modifying medical records;
  • Intentional incorrect reporting of diagnoses or procedures to maximize payment;
  • Use of unlicensed staff;
  • Accepting or giving kickbacks for member referrals;
  • Prescribing additional or unnecessary treatment; and
  • Providing false information when applying for programs.

Health care fraud may be perpetrated against public and private insurers including Medicare, Medicaid, Blue Cross Blue Shield, Workers Compensation, etc. Medicare services are divided into Part A and Part B coverage. Part A coverage includes hospital care, home health care, and skilled nursing care; Part B coverage includes physician services, laboratory tests, x-rays, outpatient services, and medical supplies.

In Michigan, United Government Services, LLC, processes Medicare Part A claims, and Wisconsin Physicians Service Insurance Corporation processes Medicare Part B claims. For Part A and Part B, Trust Solutions, LLC, is the Program Safeguard Contractor (PSC). PSC’s are contracted with the Centers for Medicare & Medicaid Services to reduce fraud and abuse in the Medicare program.

“In recent years, various state and federal agencies are cracking down on Health Care Fraud in Michigan.”

The Federal Bureau of Investigation, Department of Justice, Office of the Inspector General, Drug Enforcement Administration, Internal Revenue Service, U.S. Postal Inspection Service, and the state Attorney General are all charged with the responsibility of investigating health care fraud. Additionally, in Michigan, the U.S. Department of Health & Human Services (H&HS) combined with the U.S. Department of Justice (DOJ) established the Health Care Fraud Prevention and Enforcement Action Team (HEAT). With its creation, the fight against Medicare Fraud became a cabinet-level priority. This means that the federal government has leveraged additional resources in identifying, investigating, and prosecuting Health Care Fraud. This is sure to lead to increased scrutiny on the part of physicians, dentists, pharmacists, and other practitioners. Between 2009 and 2011, HEAT actions lead to a seventy-five (75%) percent increase in individuals charged with criminal health care fraud. During that time, HEAT has charged more than one thousand four hundred (1,400) defendants in over $4.8 billion dollars in Health Care Fraud. HEAT is also a public-private partnership which means that HEAT has combined with insurers (including Blue Cross Blue Shield) to improve fraud detection, prevent payment of fraudulent health care billings, and stop fraudulent practices that impact public and private payers. HEAT attributes its success to “cutting-edge surveillance and informants that establish crossover points between one fraudulent billing scheme to another.”

The Center for Medicare & Medicaid Services (CMS) in 2012 also launched a digital prevention and crime detection center for CMS to coordinate with law enforcement agencies that uses the Fraud Prevention Systems software’s predictive analytics to spot fraud and respond quickly to it. This means that practitioners prescribing outside the statistical norms, or treating patients in a statistically inconsistent fashion, will face increased scrutiny into their prescribing/treatment practices. Needless to say, with the increased federal presence and Medicare fraud crackdown, investigating and prosecuting health care fraud has been a prominent goal of the current administration and U.S. Attorney.

“Sentences for Health Care Fraud have increased nearly 50% since the inception of the Affordable Care Act.”

Sentences for violations of 18 USC §1347 (Health Care Fraud) can be severe. The 2010 Patient Protection and Affordable Care Act (ACA) (commonly referred to as “Obamacare”) changed, quite significantly, the sentence calculation under the Federal Sentencing Guidelines. Now, providers will be sentenced on the aggregate amount of all fraudulent bills and face increases in the recommended sentencing guidelines based on the amount of fraudulent billing. The ACA provides, the “aggregate dollar amount of fraudulent bills submitted to the government health care program shall constitute prima facie evidence of the amount of the intended loss.” Practitioners who defraud the Federal Government of over $20 million face a 50% increase in sentencing exposure as a result of the ACA.

More information about health care fraud and prescription fraud

Civil Prosecution: False Claims Act

In addition to criminal charges and administrative sanctions, civil prosecution may be pursued by the Department of Justice to obtain significant monetary damages (sometimes double or triple the actual amount of the false or fraudulent claims). The civil disposition of the false claim charges may also include injunctive and declaratory remedies.

Civil Prosecution: False Claims Act

The primary civil weapon used by the Department of Justice is the False Claims Act, 31 USC §§ 3729-3733. The FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the federal government. The “knowing” standard includes acting in deliberate ignorance or reckless disregard of the truth related to the claim. The Act allows the United States to collect triple damages and civil penalties of five thousand five hundred ($5,500.00) dollars to eleven thousand ($11,000.00) dollars per violation from persons who submit false or fraudulent claims for federal monies.

Civil Prosecution: Anti-Kickback Statute (Aks)

The AKS makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration, directly or indirectly, to induce or reward referrals of items or services reimbursable by a federal health care program. Civil penalties for violating the AKS can include fines, imprisonment, or both. If certain types of arrangements satisfy regulatory safe harbors, the AKS will not treat these arrangements as offenses.

More information about anti-kickbacks

Physician Self-Referral Law (Stark Law)

The Physician Self-Referral Law, often called the Stark Law, prohibits a physician from making a referral for certain designated health services to an entity in which the physician (or member of his or her immediate family) has an ownership or investment interest, or with which he or she has a compensation arrangement, unless an exception applies.

More information about stark law

Excluded Providers

In addition to the civil and criminal remedies outlined above, the Office of the Inspector General has the ability to impose exclusions on a number of other grounds. Providers can be excluded for violating the statutes above and a host of other administrative sanctions and criminal offenses listed in 42 USC §§1320a-7. Excluded providers cannot participate in Federal Health Care Programs for a designated period. An excluded provider may not bill federal health care programs, including Medicare and Medicaid, for services that he or she orders or performs. Practitioners will find that it is impossible to maintain privileges with a health care facility without the ability to bill Medicare and Medicaid.

Preventative Measures

Large health care fraud investigations only represent one end of the spectrum when dealing with combating health care fraud. Even practitioners who may believe that they are not at risk for sanctions or criminal charges for health care fraud must be vigilant in reviewing their policies and procedures to ensure compliance with the myriad of rules and regulations in order to avoid the possibility of large fines, licensing sanctions, or criminal charges.

Below are some of the pertinent federal statutes related to health care providers:

  • Health Care Fraud 18 USC §1347
  • False Statements Relating to Health Care Matters 18 USC §1035
  • Theft or Bribery Concerning Programs Receiving Federal Funds 18 USC §666
  • Medicare Anti-Kickback Statute 42 USC §1320a-7b(b)
  • Theft or Embezzlement in Connection with Health Care 18 USC §669
  • Criminal Penalties for Acts Involving Federal Health Care Programs 42 USC §1320a-7b(a)(3)
  • Mail Fraud 18 USC §1341
  • Wire Fraud 18 USC §1343
  • False Claims 18 USC §287
  • Laundering of Monetary Instruments 18 USC §1956
  • Engaging in Monetary Transaction in Property Derived From Specific Unlawful Activity 18 USC §1957
  • False Statements 18 USC §1001
  • False Claims Act 31 USC §3729
  • Qui Tam 31 USC §3730

As you can see, physicians face an ever-tightening web of state and federal regulations that they must abide or face severe criminal and administrative sanctions. The advice of a competent attorney, knowledgeable in all aspects of health law and particularly criminal defense of health professionals, is key in protecting your license and your freedom. Too often, physicians, dentists, psychiatrists, pharmacists and other health professionals follow the advice of attorneys who only specialize in criminal law and are then ill-equipped to defend health professionals in complex criminal cases that involve complex licensing and regulatory issues.

You need an experienced attorney who knows your profession, knows medicine, and is equipped with the knowledge to provide you with complete comprehensive representation in both arenas. Put the time-tested experience of an established health law firm to work for you. Call Chapman Law Group for a free consultation with one of our criminal/professional licensing attorneys today.

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