Health Care Fraud
While most prosecutors will only pursue cases against those who have been accused of high-dollar fraud, that isn't any guarantee that others who have been investigated for non-monetary fraud will remain uncharged. In the case of accusations of unlawfulincentives or referrals, it's best to speak with an attorney as soon as you know you are being investigated. You have rights that should be protected throughout the duration of any investigation, including before you are charged formally. One of those rights is to have an attorney present with you whenever you are requested to provide information or documents to investigators.
One tactic that investigators use is to ask for your help, while the truth of the matter is that they are beginning an investigation into your practice or services. Any information they receive from you will later be admissible in court. You cannot retract permission for them to possess the files you showed them. There are other rights you need to protect, as well. Investigators do not always rely on tips from the public, but instead use cross-matching software to catch discrepancies.
- Health care fraud, and other abuses of systems that provide medical care toindividuals are included in the practice area, as are medical abuses, including below-standard treatment of patients, physical abuse of patients, as well as nutritional abuse and neglect, neglect of socialization and other needs of patients, psychological manipulation of patients, and related areas. Patients who are being charged with health care fraud may face charges related to drug seeking behaviors, under-reporting assets in order to obtain coverage, or living out of the state in which they are applying for benefits.
- Health care fraud and its related practice areas are very complicated and include both federal and state legislation. Some cases will be investigated at the federal level, while others will be prosecuted at the state level. Some accusations may be charged as misdemeanors, and others as felonies. Much of this depends on the head of the investigative unit, and also where the information came from that started the investigation in the first place. Many cases begin with information from a third party.
- California Penal Code regarding health care fraud can be located at http://www.leginfo.ca.gov/cgi-bin/displaycode?section=pen&group=00001-01000&file=548-551.
- Federal law regarding health care fraud can be located at https://www.law.cornell.edu/uscode/text/31/3729.
List of Associated Crimes and Charges
- Falsifying documents
- Patient abuse
- Theft by deception
- Aiding, abetting, conspiring to commit fraud
- Money laundering
Each one of these, and others, can result in its own sentencing if you are found guilty. Patients can also be charged with fraud if they have sold items that were bought for them.
Prosecutors will begin investigating a case long before you are informed of any allegations. Sometimes, prosecutors will work with agents who will pose as a patient or other person, be it pharmaceutical representative or someone involved in the selling of medical aids and devices to gather more evidence against you.
- The prosecutor must be able to prove to the judge, or the jury if you opt for a jury trial, that you intentionally committed fraudulent activities, and that you also benefited from those activities with a financial gain that you would not have received had it not been for the fraud.
- Prosecutors will look at your practice's files, including medical records of patients. They will match patient records with billing records to see how well they match. They will also look at other medical providers you refer your patients to, to see how those records match up with your own. If your patients are informing the providers you referred them to that they receive such and such medical treatment, this is typically noted in their file at the other provider's office. If these other records do not match yours with several patients, the prosecutor will use this against you.
- Before, prosecutors would look at only intentional misrepresentation of facts to those paying for medical services when investigating fraud. However, now prosecutors are looking at other aspects of providers' services and how they are rendered and billed for. With the new laws in place, there is a great deal of confusion on several different aspects. Receiving payment that should not have been received and failing to return it can lead to allegations and charges of health care fraud. These are called 'improper payments.' Another area where charges of health care fraud can arise is when regulations are not followed precisely.
Who Can Be Charged
Anyone who provides goods or services in a health care setting and receives payments for those goods or services can be charged with health care fraud. Occasionally, patients are charged with health care fraud, too. This can happen when a patient sells equipment or medications that were paid for by an insurance agency, whether private or public.
- Before, intent and financial gain were the required elements, but now if investigators believe that charges were billed in a fraudulent manner in order to financially benefit those receiving the payments, or if the laws regarding reporting requirements were not fulfilled correctly. The law is changing and prosecutors are not eliminating the old elements to prosecute a case. They are, however, developing new elements to prosecute with. Many health care providers are often too busy tending to their patients to keep up on all of the new legal requirements, causing them, quite innocently, to commit acts that prosecutors will want to investigate further for fraud. Under federal law, if prosecutors can prove that an action did take place, no intent needs to be proven.
With health care fraud, defending is simple, but difficult. It is simple because no one can get into someone else's mind and really prove what someone else intended to do, and the evidence to show this to a judge or a jury is circumstantial in most cases brought to trial. It is difficult because nobody will need any other defense than lack of intent to defraud those paying for the services and goods rendered to patients. It might seem that this would make it simple to defend, but it actually makes it more difficult. This is because it is nearly impossible to show that there was no intent to defraud.
- Lack of knowledge that the charges billed for services did not match or that the bills submitted were requesting over-payments is one way to provide a defense against health care fraud allegations. If it can be proven that there was no knowledge that the practice alleged to be fraudulent was unlawful, lack of intent isn't needed to be shown.
- If a practice was recently purchased, or if the billing clerk failed at due diligence, these might be options that could be used to show that you were not attempting to gain more in payments from third-party payers.
- Because health care fraud involves payments and correspondence with government agencies, investigators have a right to know what is being paid and there is no real possibility of investigators overstepping their legal limits when pursuing information during an investigation.
Penalties can include fines, restitution, and imprisonment. There is an increased drive to prosecute such types of cases, particularly because of the number of Americans who are upset about the high level of taxes levied, and the amount of corruption involved in government. Officials use this as one way to show constituents that they are doing something about the problem.
How an Attorney Can Help
If you find yourself under investigation, you need to call an attorney immediately. These cases are hard to defend against with a public defender, or with an attorney who only cares about making money from you.
- No matter your question, I know that time is an important aspect in this type of case, and once lost it can never be regained. I will answer all of your questions in a very timely manner, which will help you in your case.
- It is VITAL that you call me now so I can begin working with you to protect not only your rights, but your license to practice, and also your very FREEDOM. Your reputation is on the line.
- Calling me gains you a free consultation and I will advise you on what you need to do to protect your rights, including gathering of documents and other evidence that I will need to examine.
- Hiring me will get you started in the right direction. I will personally accompany you into court, and not send another attorney who you don't know, and whodoesn't understand your case. I don't ask for continuances, I seek a hearing and a trial that will result in you being acquitted quickly. Those have always been my number one goals.
- It's time now to hire me and protect yourself and your future.
- Call me, Jeff Voll at 323-467-6400 and I will personally take care of your case.