Individuals charged with healthcare or Medicare fraud often face an uphill battle trying to prove their case. For those who are being questioned or fear concerns over this type of crime, it is essential to take action now. Healthcare and Medicare fraud charges can carry long-term jail time, costly fees, and other implications depending on the severity of the crime.
What Are Healthcare and Medicare Fraud Charges?
Medicare and healthcare fraud are very complex areas of the law for multiple reasons. Over the last few years, there has been a significant crackdown on claims of fraud in these areas in particular from the Federal Bureau of Investigation and the Justice Department. This type of fraud case can advance very fast and provides for significant penalties. In short, if you are facing charges, you need legal help nearly immediately to protect your rights.
The U.S. federal government is working closely with state and local agencies to identify this type of fraud. While they will prosecute anyone with evidence against them, there is a strong focus on medical and dental providers who are making fraudulent charges to Medicare or health care agencies for the wrong services, wrong patients, or other criminal acts. Additionally, there is increasing attention paid to those who bypass key compliance requirements.
Common charges include:
- Lack of medical necessity
- Billing for ghost patients, equipment not provided, services not provided, or low-quality services
- Utilizing excluded providers
- Billing unbundled services
- False claims
- Violating Medicare assignment provisions and many others.
Examples of Key Recent Charges and Actions
There are many instances of charges for health care and Medicare fraud being tackled by a variety of government organizations. Here are a few key examples:
- A 52-year-old man was sentenced to six months in federal prison for making false statements to the Florida Medicaid Program. He was the former Wellcare General Counsel in the matter.
- An owner of two defunct Miami home health care agencies recently received six years in prison for his role in a $74 million Medicare fraud case.
- Two people, a medical doctor and his business partner, were indicted for $7.1 million in Medicare health care fraud in Las Vegas. The scheme involved three hospices in the community.
These are just a few examples, but important ones. As you can see, these types of claims apply to individuals, businesses, partnerships, and a variety of organization types. And, they all result in significant fines. If you are facing these types of charges, now is the best time to take action by hiring a criminal defense attorney.
Penalties for Medicare or Healthcare Fraud?
This is a very complex area of law in that there are many types of charges that can be brought both civil and criminal. Some of the most common sanctions include the following:
- Jail time is very much a possibility. Generally, this can be up to 10 years, but if bodily injury is a component of the claims, this can rise to 20 years.
- Charges of the False Claims Act can result in five years of jail time per occurrence, up to a lifetime for multiple counts.
- Wire fraud can result in up to 20 years of jail time.
- Conspiracy to Commit Healthcare Fraud can provide individuals with up to 20 years in jail.
- Monetary penalties are numerous. False Claims Act costs can amount to as much as $250,000.
- Anti-Kickback Statute claims can amount to $50,000 per violation and a fine of three times the amount of the kickback.
- Restitution is also common.
- Healthcare fraud claims can equate to $250,000 in fines.
Perhaps most importantly, there is the loss of licensing in a variety of industries. DEA registration loss is also lost. There is also the potential to be excluded from Medicaid or Medicare, suspension of any invoices that are outstanding, and a loss of staff privileges is common.
What Defense Options Do You Have?
It is possible to defend against these types of charges. If you know you are facing such charges, your goal may be to fight them outright especially if you know them to be wrong. With the help of witness statements, documentation, and professional testimony, it may be possible to reduce or eliminate your charges in a court of law. However, many times, criminal defense attorneys can also help you to reduce jail time and fines you pay if you are convicted.
Keep in mind that you will be facing some of the most experienced and trusted prosecutors out there. This means it will be hard for you to prove your case without an attorney that has exceptional experience in this area. Every case is vastly different, but working with the right attorney is essential to help you overcome these charges with the best possible result.
What Should You Do Right Now?
If you are facing accusations, charges, or questioning, schedule a free consultation with Las Vegas criminal defense attorney Gabriel L. Grasso. Contact us today by calling (702) 868-8866. You do not want to face high-powered prosecutors on your own.