Healthcare fraud is a major government priority right now. The Department of Justice, the Department of Health and Human Services’ Office of Inspector General, and local Attorneys General are spending tremendous resources investigating and vigorously prosecuting health care fraud cases. Prosecution under the Medicare Anti-Kickback Statutes is expanding and what was formerly viewed as billing error is now being prosecuted as fraud and abuse. Targets of healthcare fraud prosecutions include physicians, DME suppliers, home health care agencies, clinical laboratories, telehealth companies, etc., etc.
Healthcare fraud is investigated and prosecuted by the Department of Justice (DOJ), the Department of Health and Human Services (DHHS) Office of Inspector General (OIG), and the Drug Enforcement Agency (DEA). Investigators use confidential informants, former employees, and other people who have inside information to assist in the investigation and prosecution of federal healthcare fraud cases. As a result, simple errors may be incorrectly identified as potential fraud, which can lead to an intrusive investigation.
If you are under investigation or have been charged with healthcare fraud, you need an experienced criminal defense lawyer on your side; someone who will vigorously oppose the government’s investigation, and has the experience, expertise, and tenacity to go toe-to-toe with the most aggressive federal prosecutors and win.
Healthcare fraud is investigated by the FBI, DEA, and OIG and is prosecuted by the United States Attorney of the Department of Justice (DOJ). Healthcare fraud cases may be prosecuted under:
Prosecutors are targeting physicians, pharmacists, compound pharmacies and other healthcare providers that they suspect are improperly prescribing, dispensing and administering prescription medicines. In addition, for medical services, prescription medications, or healthcare supplies or equipment to be eligible for Medicare or other federal program reimbursement, they must qualify as “medically necessary.” Services are considered medically necessary when they are “needed to diagnose or treat an illness, injure, condition, disease or its symptoms and that meet accepted standards of medicine.” Whether or not a provider has conformed to this standard can be a grey area that is ripe for prosecution.
When medical practices, clinics, and other healthcare providers falsify patient records in order to bill higher amounts, or routinely bill higher volumes or amounts than the regional or national averages, this billing issues can trigger investigations.
The False Claims Act is one of the most powerful tools that the federal government has for prosecuting healthcare fraud. This Act is an extraordinarily broad statute that imposes both civil and criminal liability for any “false or fraudulent” claim submitted for federal healthcare program reimbursement. The determination of was is “false” is really subject to much abuse by the prosecution. False claims refers to all coding errors, billing errors, certifications etc. that a provider makes in connection with a claim for payment. The regulatory schemes that govern reimbursement are extremely complex and are being used by the prosecution to criminalize violations of these rules.
Under the Medicare Anti-Kickback Statute, it is illegal for any healthcare provider to “knowingly and willfully” offer payment or remuneration (including any kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in-kind to any person to induce a patient referral under a federal health care program. In addition, the Stark Law prohibits any transaction that qualifies as a “physician referral” to any entity with whom the physician has a financial relationship.
People charged with healthcare fraud will often face additional criminal charges, including:
In addition to serious criminal penalties, prosecution for healthcare fraud can lead to significant collateral consequences such as:
New York City federal criminal defense attorney Hope Lefeber has more than 30 years’ experience defending people accused of crimes in federal court. She began her career as an enforcement attorney with the United States Securities & Exchange Commission (SEC) where she learned first-hand how the government prepares and prosecutes criminal cases. Today, she uses that experience to defend people accused of federal crimes.
Hope Lefeber has earned a reputation as a fierce defender and tireless protector of her clients’ constitutional rights. She is highly respected by her colleagues in the federal bar, federal prosecutors, federal judges, and her clients. Ms. Lefeber is well-known for her thorough preparation and meticulous attention to detail and has successfully defended people who have been accused of all types of crimes in federal court. She has received numerous accolades and honors for her work and has represented high-profile clients, lectured on federal criminal law topics, and been asked to appear on TV as a legal expert. Ms. Lefeber is held in the highest esteem by her colleagues and the judges before whom she has appeared.
If you are under investigation or have been charged with healthcare fraud in New York City, you need an experienced federal criminal defense attorney on your side as soon as possible. Hope Lefeber has been defending people accused of crimes in federal court for more than 30 years. She is a fierce and tenacious advocate for her clients and is tireless in her pursuit of justice. She is meticulous in her preparation and vigorously defends her clients’ rights. She takes a hands-on approach to every case she handles and thoroughly reviews and evaluates every piece of information the government intends to introduce as evidence.
If you are under investigation or have been charged with healthcare fraud, contact Hope Lefeber to schedule a free, confidential consultation to discuss your case. Call 610-668-7929 or complete the online form.