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Health Care Fraud

Federal Health Care Fraud Attorney – 18 U.S.C. § 1347

As health care fraud becomes an increasingly prevalent concern, more lawsuits are filed against health care providers. The laws relating to such lawsuits are in constant flux. It is important that any health care provider accused of fraud hires the best defense attorneys available lest they risk losing their business. Federal health care fraud is so common, the FBI post daily information on their website on health care fraud investigations.

Federal health care fraud accusation can cover a wide range of allegations. Federal prosecutors could pursue criminal charges under a variety of federal statutes. If you are the target of a federal fraud criminal investigation, you need to be proactive to protect yourself against the accusations.

Defraud a Health Care Benefit Program

18 U.S.C. § 1347 makes it a federal crime to defraud a health care benefit program or to fraudulently obtain any money.  The key factor in any type of federal health care fraud case is the “intent to defraud.”

Normally, you demonstrate the intent to defraud when you use false pretenses, promises, or misrepresentations to obtain money or services to which you are not entitled to receive.  The form of fraud can usually vary depending on the type of benefit program or the goal of the fraud, whether it's to obtain cash or valuable service.

For instance, you might be charged with making false claims that you meet eligibility requirements for a specific healthcare benefit program when you don't actually qualify.

Some programs will require recipients of benefits to fall below a specific income level, known as “means testing”, which is very common in a lot of federal benefit programs.

Let's say you know you are supposed to have an income of under $40,000 annually to qualify for benefits – but you actually make much more – making you ineligible for healthcare benefits program.  However, when completing the registration paperwork for receive healthcare benefits, you falsely claim you make under $40,000 in order to be accepted.

The moment you receive either subsidized medical treatment, or a cash benefit, you just committed healthcare benefits fraud, due to the fact you knowingly and willingly gave false representation for the purpose of defrauding the medical program to give you service or payment that you knew you were not entitled to receive.

Having knowledge the fraudulent conduct is illegal under federal laws is not required for a conviction. If you know you are making fraudulent statements or representations in order to obtain money or services through a federal healthcare benefit program, this is sufficient for a conviction.

A violation of 18 U.S.C. § 1347 for federal healthcare fraud is punishable by up to 10 years in federal prison and/or a fine.  If the violation resulted in serious bodily injury to someone, your sentence could be increased to 20 years.  If it resulted in death, you could face a life sentence.

Health Care Fraud Investigations

You won't always know initially the exact reason why you are a target. Maybe it has been alleged you were involved in over-billing Medicaid. Perhaps there are allegations you used reimbursed money from Medicare to pay for a  referral fee kickback.  Until you know for sure why you are the target of a federal criminal investigation, you won't know how exactly how to prepare a solid defense strategy.

After a health care provider learns they are the target of a federal criminal investigation, most don't know why as they believe they have properly followed the regulations of the of the health care benefit program. Many providers have a false assumption federal prosecutors will only pursue complex high-dollar fraudulent schemes.

This simply is a myth and the enforcement of Medicare benefits has changed over the years because there are literally thousands of healthcare providers across the United states with billions of dollars paid.

Fraud has substantially increased and the federal law enforcement agencies responsible for investigating bogus claims are often overwhelmed.  With advancement in technology, it has now become easier for the agencies to identify and target suspicious activity involving fraudulent billing activity. Health care providers might receive a subpoena from the Office of Inspector General.

Common Fraudulent Activity in a Health Care Investigation

Many health care providers have found themselves a target in federal billing fraud investigation. Federal agents are experienced and know the common themes of healthcare fraud. A conviction will typically carry severe penalties. Some of the most common forms of healthcare fraud include the following:

  • Billing for unnecessary medical services or services that were never provided
  • Falsification of patient records, including prescriptions
  • Solicitation or acceptance of referral fees, known as a “kickback”
  • Submitting false information to CMS or other relevant federal agency
  • Billing individual services rather than a bundle that is required by guidelines
  • Incorrect billing, such as submitting billing for a higher rate than allowed
  • Prescribing medications that are not necessary, or other types of prescription fraud
  • Double billing a federal benefits program

If you are currently under a federal health care fraud investigation, you need to protect yourself immediately. Our experienced federal criminal lawyers know how to deal with a health care fraud case and will get to work right away to find out what exactly your are dealing with and how to protect you against the charges. We assist healthcare companies and professionals, in all fraud and abuse laws:

United States Code Section 1347 provides punishment for any person who knowingly executes, or attempts, a scheme to defraud a health care benefit program, or to obtain by fraudulent pretenses, money or property under custody of a health care benefit program.

Health Care Fraud Conspiracy – 18 U.S.C. § 1349

18 U.S.C. § 1349 federal healthcare fraud as can be charged as a conspiracy when one or more people make an agreement to commit healthcare fraud together. Again this could occur in many forms.

Let's take an example where group of people conspire and agree to recruit other others to claim eligibility for some federal healthcare program benefits – and send the qualified individuals to a doctor who is also a participant in the conspiracy.

The people in the community receive a payment – or “kickback” – while the doctor receives reimbursement from the federal benefits program for providing medical services to the people who were recruited.

In truth, the doctor didn't provide the services they are claiming from the government. For their role in recruiting patients – recruiters, known as “cappers” – receive a kickback.  In this manner, the conspiracy functions by paying a variety of the members in the conspiracy through fraudulently obtained federal healthcare benefit money.

This example illustrates that every person involved knew their activity was fraudulent, including the doctor, recruited patients and the “cappers, and all could be charged with 18 U.S.C. § 1349 federal healthcare fraud conspiracy.

A conspiracy to commit healthcare fraud can be punished by 10 years, 20 years, or even life in federal prison depending on any enhancements for injury or death.

Federal Criminal Defense Law Firm

If you or a family member is charged with committing federal health care fraud, under 18 U.S.C. § 1347 or 1349, contact our federal criminal defense attorneys for a consultation.

If you were contacted by a federal law enforcement agency, you need advice from an experienced federal defense lawyer right away.  It may be possible to resolve your case without going to trial and you may be able to avoid charges from being filed.

Many cases can be resolved during the investigation process, but we need to closely examine the details of your situation in order to develop a game plan for best outcome.

We will protect your rights in the investigative stage of the case before a formal filing, and potentially negotiate a pre-indictment resolution with the prosecutor, or litigate your case in federal court including through a federal jury trial.

It is important if you have been accused of health care fraud that you seek the advice of knowledgeable attorneys immediately. Call Eisner Gorin LLP at 877-781-1570 or fill out online contact form.

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