Health care fraud charges usually arise when an individual or company defrauds a federal government healthcare program or insurer. Health care providers, including doctors, nurses, nurse practitioners, and physical therapists, are the most common defendants in health care fraud cases.

Many cases of health care fraud are prosecuted under federal law. If you have been charged with health care fraud in the Commonwealth of Pennsylvania, it is essential that you have experienced legal representation on your side throughout your entire case.

Attorney Brian J. Zeiger has the knowledge and expertise to safeguard all of your legal rights while your criminal case is pending and can help you formulate potential legal defenses to your criminal charge.   

Types of Health Care Fraud

The most common examples of health care fraud include the following:

  • When a health care provider engages in the illegal practice of “upcoding” services – or billing for services that were costlier than the services that were actually rendered to the patient
  • When a health care provider engages in the illegal practice of “upcoding” items – or billing for items that are costlier than what the patient actually received
  • When a health care provider bills for duplicate services, which includes billing Medicare twice for the same or similar services by slightly altering the bills and invoices
  • When a health care provider bills for unnecessary services, which usually involves filing Medicare claims for care that a patient did not require under the circumstances

Elements of Health Care Fraud

In order for a federal prosecutor to prove health care fraud, she must prove all of the following elements “beyond a reasonable doubt”—or beyond a doubt based upon ordinary reason and common sense:

  • That the defendant knew the health care claim was false or fraudulent
  • That the defendant intended to defraud the medical insurance company or program—or knowingly provided unnecessary services

Possible Defenses to Health Care Fraud Charges

The following defenses may be applicable in cases where a criminal defendant is charged with committing health care fraud:

  • Lack of knowledge or mistake of fact – in cases where a doctor or other medical professional is careless or makes a billing mistake
  • Lack of specific intent to defraud – in cases where a health care provider does not intend to commit a crime or does not intend to defraud anyone

Possible Penalties

Crimes involving health care fraud are serious and can result in severe criminal penalties, depending upon the amount of the claim involved. If the crime is deemed a felony, the defendant could also be subject to jail time.

Contact a Philadelphia, Pennsylvania Health Care Fraud Defense Attorney Today to Discuss Your Case

If you have been charged with health care fraud, it is essential that you have experienced legal representation in your corner every step of the way. Attorney Brian J. Zeiger can discuss the facts of your case with you, work with you to formulate legal defenses to your charge, and represent you in court.

To schedule a free consultation and case evaluation with a Philadelphia, Pennsylvania health care fraud defense lawyer, please call us or contact us online. 

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