An arrest and charge for healthcare fraud can threaten more than just your professional reputation; a healthcare fraud arrest can threaten your very future. Any healthcare provider, nursing home, pharmaceutical company, or other individual or organization that receives Medicare, Medicaid, or another government payment is at risk for an accusation of healthcare fraud. Contact us today to speak with a Philadelphia criminal attorney at The Zeiger Firm.
It is important to understand the nature of healthcare fraud and why you need an attorney as early as possible. Healthcare fraud is a type of fraud committed by doctors, hospitals, nursing homes, insurance companies, pharmaceutical companies and others involved in healthcare. Doctors, hospitals, pharmacists and others may be charged with healthcare fraud if they engage in false billing, diversion of drugs, diversion of medical equipment and other illegal behaviors.
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
The penalties for healthcare fraud are serious. Penalties can include jail time, professional sanctions, the loss of professional licenses and other punishments. Further, reputations can be ruined, damaging personal and professional futures.
Given the seriousness of this crime, your attorney must build your strongest defense possible and do so as early as possible. The Philadelphia, Pennsylvania attorneys at The Zeiger Firm understand the many laws that apply to these cases, and we zealously will investigate and defend you against the charges. With aggressive investigation and lawyering, our attorneys will try to convince the authorities to drop and dismiss cases at their inception. When cases do go forward, our criminal defense attorneys aggressively and zealously will defend you against these charges.
The Federal Bureau of Investigation, the U.S. Attorney’s Office, as well as state and local law enforcement agencies, have assembled teams of investigators and prosecutors who handle these cases. To fight these charges, you need defense attorneys who have handled these cases and understand the nature of the charges and how to fight them.
Contact a Philadelphia Healthcare Fraud Defense Lawyer
When you need a Philadelphia, Pennsylvania attorney to defend you when arrested and charged with healthcare fraud, contact The Zeiger Firm, who represent every client zealously in order to obtain the best results possible in each case. To arrange a consultation, please give us a call at 215-546-0340 or send us an email via the form to the left.
