Health Care Fraud Defense

Our team of health care fraud attorneys includes a former Medicare attorney and a Medicaid fraud prosecutor. These attorneys have extensive experience handling both civil and criminal health care fraud cases, including false claims, kickbacks, fee-splitting, patient brokering, stark, and other types of health care fraud. Our health care fraud defense attorneys defend providers and suppliers nationwide. Their clients include physicians, pharmacists, home health agencies, compound pharmacies, urgent care centers, and behavioral health facilities who have been accused of health care fraud.

Health care fraud is an extremely complicated area of law. In contrast from other health law matters, health care fraud cases progress very quickly and carry significant penalties and fines. Often the key to a strong defense is one that is prepared as early as possible. Even the mention of health care fraud can trigger licensing investigations and Medicare and Medicaid audits. We work with health professionals to not only defend against health care fraud charges, but prepare them for investigations and audits.

Health Care Fraud Investigations and Audits

In recent years the federal government has teamed up with state and local government to aggressively identify and stop health care fraud. The investigators are often ruthless and use confidential informants, previous employees and others with potential inside information to assist in the investigation and prosecution. As a result, incidental errors or negligence are often identified as potential fraud. The Medicare/Medicaid billing manuals/procedures are not easy to understand and often coding errors and simple misunderstandings lead to adverse consequences. With significant increases in funding from the federal government for health care fraud audits, health professionals are often faced with intrusive investigations. These investigations and audits do not resolve themselves! The assistance of a health care fraud attorney that understands CMS regulations and state and federal fraud and abuse laws should be retained at the earliest possible time to limit exposure and help ensure a positive outcome.

If you have been 1) arrested for health care fraud, 2) contacted by federal or state/local law enforcement, 3) contacted by a medical insurer raising questions of potential fraud, contact a health care fraud attorney as soon as possible. The allegations are very serious and prosecutors will often try obtaining information from you before you have retained an attorney. Please don’t give authorities or the prosecutor information without first seeking counsel.

Examples of Health Care Fraud

  • Kickbacks
  • Submitting false claims to CMS for payment
  • Billing for ghost patients
  • Billing for services not provided
  • Billing for equipment not provided
  • Billing for services of such low quality that they are virtually worthless
  • Up-coding
  • Billing unbundled services
  • Overutilization of certain medical procedures or services
  • Lack of medical necessity
  • Utilization of excluded providers
  • Making false statements on applications or contracts to participate Medicare or Medicaid program
  • Providing false or misleading information expected to influence a decision to discharge a patient
  • Violating Medicare assignment provisions or the physician agreement

Health Care Fraud Sanctions

Our goal is not only to resolve health care fraud charges and minimize penalties, our goal is also to protect the provider’s professional license and practice. Unlike most criminal defense attorneys, our attorneys are also experienced with administrative sanctions and employment issues that result from health care fraud allegations. Health care fraud allegations can have a widespread effect on licensure, CMS eligibility, NPDB, staff privileges, credentialing issues, etc. From the onset, we consider these issues when handling the civil and/or criminal health care fraud cases. Additionally, upon resolution of a health care fraud case, our attorneys are able to handle the administrative and employment issues that may result from health care fraud allegations and/or convictions.

Possible Sanctions for Health Care Fraud

  • Jail Time:
  • Healthcare Fraud: up to 10 years. Up to 20 years if bodily injury
  • Conspiracy to Commit Healthcare Fraud and Fraud: up to 20 years
  • False Claims Act Convictions – up to 5 years per occurrence. Up to Life if convicted of multiple counts
  • Money Laundering: up to 10 years
  • Conspiracy to Commit Money Laundering: up to 20 years
  • Wire Fraud: up to 20 years
  • Civil Monetary Penalties:
  • False Claims Act – up to $21,563 per claim and a fine three time the amount of damages sustained by the government as a result. Fine up to $250,000 if knowingly
  • Anti-Kickback Statute – up to $50,000 per violation and a fine three times the amount of the kickback
  • Health Care Fraud – up to $250,000
  • Exclusion Statute – up to $10,000 per item claimed while excluded and a fine three times the amount claimed
  • Restitution
  • Other Sanctions and Collateral Consequences:
    Loss of Licensure
  • Loss of DEA Registration
  • Exclusion from Medicare and Medicaid
  • Suspension of Payment on Outstanding Invoices
  • Loss of Staff Privileges

Unlike most criminal defense attorneys, our criminal defense attorneys are dedicated to representing health care providers and are knowledgeable in issues specifically related to health care crimes, including fraud detection, CMS regulations, the standard of care, the Controlled Substances Act, and conditions of participation and payment. Our health care fraud defense attorneys are licensed in Michigan, Idaho, Ohio, and Florida and represent providers nationwide. We are willing and able to assist you in all aspects of health care fraud: investigations, criminal defense, professional licensing defense, etc. Please contact us for a free consultation with our health care fraud defense attorneys. We have health care fraud defense attorneys in Detroit, Miami, Tampa, Boise, and Columbus areas.


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