Healthcare Fraud Defense Lawyers in Birmingham
The complexities and intricacies of the healthcare system expose it to fraudulent behavior. While there are safeguards in place to protect against fraud, those with in-depth knowledge of healthcare systems can often carry out detailed fraud schemes for years before being caught. Since these schemes often involve state or federal funds and agencies, the consequences can be severe. If you’ve been accused of healthcare fraud or you have reason to believe that you are under investigation, it’s time to start preparing a defense.
At Kirk Drennan Law, we have extensive experience in white-collar crime and protecting clients’ rights when they’re under the microscope. Find out how we can help you—call our Birmingham office at 205-803-3500 to schedule a consultation now.
What is Healthcare Fraud?
The term “healthcare fraud” covers a wide range of illegal activities that involve misusing healthcare claims and services in order to funnel money to other individuals or groups. Schemes vary, depending on which type of facility or corporation is involved and what type of information the individual or group has access to.
Healthcare fraud is a serious issue in the United States because healthcare insurance providers spend a significant amount of time and money combating fraud. Those costs are passed onto consumers, driving up prices for everyone.
This type of fraud is often investigated by the U.S. Postal Service, the Office of Inspector General, and the Federal Bureau of Investigation, depending on which services are used to perpetuate the fraud.
Some common types of healthcare fraud include:
- Medicare and Medicaid fraud
- Fraudulent Medicare and Medicaid billing
- Fraudulent prescriptions
- Illegally importing or exporting regulated medications
- Bribing licensing boards
- Lying to licensing boards
- Obtaining unneeded prescribed pills and reselling them to profit
- Changing the dates, services, or patients in order to get insurance to cover a service
- Altering medical records
- Using unlicensed staff
- Billing for services that were not provided
- Filing duplicate insurance claims for one service
Many healthcare fraud investigations target doctors, nurses, CNAs and PCWs, healthcare facilities, pharmacies, insurance companies, pharmaceutical companies, and others within this industry. While consumers of healthcare services can commit fraud—for example, by illegally obtaining prescription medication—many investigations target providers and facilities running larger schemes.
Relevant Federal Laws
A wide range of federal laws strive to prevent and punish healthcare fraud. They include:
- False Claims Act. The goal of the FCA is to protect the government from being sold low-quality goods and services. It protects the Medicare and Medicaid programs from being defrauded by physicians and other care providers. Fines pile up quickly for providers running large-scale schemes since false claims result in fines that are three times the program’s loss and an additional $11,000 per false claim. Not only are perpetrators at risk of being discovered by the government, but they can also be turned in by patients. Whistleblowers can file on behalf of the United States and recover a portion of the fines. In addition to the civil penalties associated with the FCA, there are criminal penalties.
- Anti-Kickback Statute. It is illegal to pay or receive kickbacks for anything that is payable by Medicare or Medicaid. Under this law, a kickback isn’t just a cash incentive. Anything with value can be considered a kickback, including travel expenses, high-paying medical directorships or consulting roles, and living expenses. Kickback schemes often target doctors, since they have access to a stream of patients that may need (or be convinced that they need) certain prescription medications or services.
- Physician Self-Referral Law. This law forbids physicians from referring patients to Medicare- and Medicaid-payable health services if the person providing the service has any sort of financial relationship with the physician or a family member. Consider, for example, a physician that owns a stake in a clinical laboratory. If they refer patients to that laboratory for diagnostic testing, they may be in violation of this law. Something that sets this law apart from many others is that it does not require intent. Even if one is not intending to break the law, they can still be penalized.
- Exclusion Statute. This law outlines which care providers and entities cannot participate in federal healthcare programs like Medicare and Medicaid. Those who are excluded include those convicted of Medicare or Medicaid fraud, those convicted of patient abuse or neglect, those with felony convictions for other healthcare-related fraud, and those with felony convictions related to controlled substances.
- Civil Monetary Penalties Law. The Civil Monetary Penalties Law permits the Office of Inspector General to seek penalties for many types of illegal and fraudulent conduct. Fines range from $10,000 to $50,000.
What a Conviction Could Mean for You
A healthcare fraud conviction could have a devastating effect on your medical career and other aspects of your life. On top of that, you could face standard criminal penalties, including prison time and fines.
For example, a fraudulent Medicare or Medicaid Claim could result in multiple years in prison. Fines for fraudulent claims can be hundreds of thousands of dollars per claim for individuals and organizations. On top of that, those who are convicted are generally required to pay restitution to affected individuals and organizations.
How could healthcare fraud affect your career? As noted above, being convicted of healthcare fraud could bar you from ever providing services to those on Medicare, Medicaid, Tricare, or other federal healthcare programs. You also risk the loss of your licensure, termination, and an inability to ever work in this field again.
Yes, You Need a Healthcare Fraud Defense Lawyer—Here’s Why
A single healthcare fraud conviction could result in years in prison, hundreds of thousands of dollars in fine, and the decimation of your career. This is not the time to take chances and hope that the odds are in your favor, Instead, choose an attorney who will fight aggressively to protect your rights and minimize the fallout of your charges. At Kirk Drennan Law, we understand how a misunderstanding or mistake can snowball. Our team will explore a wide variety of potential defenses and create a plan that protects your rights, freedoms, and future.
Find Out How Kirk Drennan Law Can Help You
If you have been accused of healthcare fraud, do not wait any longer to get the legal assistance you deserve. The team at Kirk Drennan Law is ready to learn more about your case and tackle your charges aggressively. Reach out online or call us at 205-803-3500 to schedule a consultation.