Make no mistake about it, over the past few years, the federal government has targeted healthcare professionals for prosecution. Many United States Attorney’s offices even have prosecutors dedicated solely to prosecuting healthcare fraud. Moreover, this focus has lead to an increase in investigative agents investigating healthcare fraud claims and the need for these agents to justify their existence. Meanwhile, even being investigated or charged with healthcare fraud can be disastrous for a healthcare professional. Even without a conviction, it can effect the provider’s license as well as his or her ability to accept medicare/medicaid.
So what should a healthcare practitioner do if they learn they are being investigated for healthcare fraud?
The easy answer is that they should contact a federal criminal defense lawyer immediately. The question then is, which lawyer? In our experience, many will go out and hire former prosecutors for substantial sums of money and some of those former prosecutors will imply that, with their connections in the Department of Justice, the case will go away. Unfortunately, this rarely happens and there is a big difference between prosecuting healthcare fraud cases and defending healthcare fraud cases. Moreover, some of these firms will churn the cases with partners and associates in order to justify the fees. Meanwhile, as time drags on, the collateral damage to the healthcare providers continue to mount.
Broden & Mickelsen will compare its record in healthcare fraud cases with any firm. For example, the firm recently represented two doctors who had already been indicted for healthcare fraud in the Eastern District of Texas. Afer an extensive investigation, with defense experts and defense investigators, we convinced prosecutors to dismiss the charges outright against one doctor and return seized moneys to her and to also dismiss the case against the other doctor after a year of pretrial diversion. Prior to hiring Broden & Mickelsen, the doctors had consulted with former prosecutors who were asking for a retainer in excess of $1 million dollars.
In another example, a healthcare provider hired Mick Mickelsen for a case pending in the Southern District of Mississippi after she fired her previous attorney. After a complete investigation and several trips to Mississippi, Mick convince the US Attorney’s office there to dismiss the charges.
We have seen many occasions where healthcare fraud charges are pursued despite the fact that the healthcare provider had absolutely no intention to engage in any type of fraud. Many times the charges arise out of sloppy billing practices and many times they arise out of billing errors made by the provider’s billing firm.
If you learn you are being investigated for any type of healthcare offense, the sooner you get an attorney involved the better. We will be happy to sit down with you and map out a plan for a successful offense and a successful defense. Moreover, we will not churn the case for excess fees and we will always keep in mind that the longer the case goes on the more potential there is for collateral damages to your practice. Meanwhile, if a trial does become necessary, our record of “not guilty” verdicts in federal court can compare to any firm in the nation.
Read our Recent Update on this topic during COVID-19 Pandemic
What Is Healthcare Fraud?
Healthcare fraud comes in many forms, but can be generally defined as any crime that is committed that is involved with defrauding a health insurance policy says Dallas area criminal defense lawyer Clint Broden.
Examples of Provider Healthcare Fraud
- Sending bills for services never performed
- Falsifying test results or diagnoses in order to justify unnecessary treatment
- Billing for a service that is more expensive than the one performed
- Taking kickbacks for patients that were referred from elsewhere
- Other forms of patient over-billing
Examples of Consumer Healthcare Fraud
- Making insurance claims for services or medications not received or needed
- Forging receipts, bills, or medical documents
- Impersonating another person to use their coverage
Healthcare Fraud During a Pandemic
While the surface context of COVID-19 healthcare scams might be different, the structure of them remains largely the same. Telemarketing calls, phishing e-mails, and even door-to-door visits are being used to scam thousands of people out of their insurance information.
Other fraudsters have focused on bogus cures, fake test kits, and unproven treatments in order to fleece unsuspecting consumers of their healthcare dollars.
Typical Health Insurance Frauds Punishment
The maximum prison time for a healthcare fraud charge is 10 years according to federal regulations, but this number can double in cases where someone was physically harmed as a result of the fraud or scam.
Medical Identity Theft: A Growing Concern
The problem of medical identity theft has been growing for some time, and it is now feeding off the instability in an over-worked system that is bogged down by the ongoing COVID-19 pandemic.
Impersonating a doctor is a common form of medical identity theft, allowing fraudsters to write (& sell) prescriptions, a bill for expensive (& fake) services, or even simply get someone to willingly hand over all their personal information.
Defending Yourself Against White-Collar Crime in Healthcare
The best way to defend yourself against healthcare fraud is to learn to recognize the red flags. Any phone call, e-mail, or in-person visit can be an attempt to steal your personal medical information and can lead to an expensive consequence.
Being charged with healthcare fraud can result in up to 10 years in prison, but it could be a lot more if the fraud led to someone’s personal injury. In cases like these, experienced criminal defense attorneys need to be contacted as soon as possible.
Healthcare Fraud Defense Attorneys in Dallas Broden & Mickelsen, LLP
2600 State St Dallas,