Health Care Fraud and Prescription Fraud 18 U.S.C. §1347

Recently, the Federal Government and insurers have increased their ability to scrutinize Medicare billing and spot “suspicious billing patterns.” Health care professionals face scrutiny from various agencies assigned with combating health care fraud, prescription fraud and Medicare and Medicaid fraud:

  • Recovery Audit Contractors (RAC’s),
  • Medicaid Fraud Control Unit (MCFU),
  • State investigators,
  • HHS-OIG Department of Health and Human Services- Inspector General,
  • Medicare Fraud Strike Force, and
  • Health Care Fraud Prevention and Enforcement Team (HEAT).

Complications with the indiscriminate use of this technology has led to an increased number of health care providers facing health care fraud allegations. The implementation of the ACA and ICD10 will further complicate these issues namely because ICD-10 increases the 13,500 codes to nearly 70,000 billing codes. Chapman Law Group anticipates a near term spike in false fraud allegations against health care professionals as a result of ICD10 implementation. Moreover, providers who lack the time, resources and support staff to properly implement ICD10 will risk health care fraud allegations as a result of “improper billing practices.”

Knowledge of billing practices, documentation practices and the standard of care is crucial in defending these allegations. Early preparation of a criminal defense can prevent criminal charges, licensing issues, and suspension of billing privileges. Often, resolution of health care fraud allegations requires a deep understanding of medicine and the law in order to justify certain billing practices.

When faced with a health care fraud issue, you need an attorney skilled in representing licensed health professionals in criminal, civil, and administrative issues related to health professionals. Routinely, health professionals facing health care fraud related issues turn to a criminal attorney for assistance. However, without comprehensive representation skilled at dealing with the wide range of licensing, criminal, civil and administrative issues that require attention when a health care professional is facing health care fraud allegations, health care professionals are left ill-equipped to deal with the collateral consequences of health care fraud allegations.

For instance, a typical health care professional facing health care fraud allegations will also face DEA registration revocation, state licensing action, OIG exclusion, a negative national practitioner’s databank entry, hospital credentialing issues, and suspension of billing privileges.

Here at Chapman Law Group, we have significant experience in representing licensed health care professionals in the range of health care fraud related investigations and proceedings in Michigan, Idaho, and Florida. When you retain Chapman Law Group, you can take comfort in the advice and assistance of a skilled team of health law attorneys prepared to fight for you to retain your most precious asset – your license to practice and your freedom. Nearly all of our clients are licensed health care professionals like you struggling with licensing, criminal, administrative, or compliance issues.


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