DC Federal Health Care Fraud Attorney

United States health care a multi-trillion dollar industry, with the nation expected to spend more than $3 trillion on health care this year, according to the FBI. With so much money and benefits exchanging hands, the motive and opportunity to commit health care fraud is rampant. Statistics show that approximately 10 percent of health care costs—10 cents on every dollar—pay false claims. Coming under investigation for Medicare fraud or other health care fraud can be personally and professionally devastating. For many of those suspected of fraud, an investigation begins long before the individual involved has any knowledge that he or she has been flagged for fraudulent activity. Once a provider learns that he or she is under federal investigation, they should immediately contact an experienced and knowledgeable DC federal health care fraud attorney.

Federal health care fraud charges are investigated by federal agencies and prosecuted by the U.S. Attorney’s Office.

Making fraudulent health care claims for personal financial gain can seem like a profitable and easy enterprise. The opportunity for quick cash can be an overwhelming temptation for some health care providers. However, the lure of “easy money” can trap a practitioner in a painful snare. The criminal penalties—including heavy fines and extensive prison terms—can far outweigh any temporary financial benefit gained by illegal means.

Medicare fraud, Medicaid fraud, and health insurance fraud cost taxpayers billions of dollars annually. In order to crack down on health care fraud, the federal government coordinates a number of programs with agencies to investigate and prosecute fraud and false claims. These include the FBI’s health care fraud initiatives, the Department of Justice (DOJ), the Department of Health and Human Services Office of the Inspector General (HHS-OIG), the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the National Health Care Anti-Fraud Association, and the National Insurance Crime Bureau (NICB).

Types of Health Care Fraud

Any health insurance provider can become a target for health care fraud, but Medicare fraud and Medicaid fraud are among the most visible and rampant types of health care fraud. Individual patients may perpetrate insurance fraud by falsely claiming Medicare benefits or other health care benefits, but the most common culprits in health care fraud schemes are the medical providers themselves.

Common health care fraud schemes include the following:

  • Identity theft;
  • Unauthorized use of a patient’s Medicare number;
  • Fraudulent billing for services that were never rendered;
  • Billing for medical equipment that was never provided;
  • Up-coding, or inflating billing to indicate a doctor provided more costly services than actually the patient actually received;
  • Unbundling
  • Billing for more expensive medical equipment than was actually provided to the patient;
  • Performing unnecessary diagnostic tests and medical procedures in order to bill for them.

Each of these acts is intended to give the provider more reimbursement than he or she has earned. In the case of private healthcare insurance fraud, the act victimizes not only the insurer but also the patient who may be saddled with the remaining cost of an expensive procedure or equipment which he or she never needed.

Federal Health Care Fraud Law

There are a number of federal statutes and regulations pertaining to health care fraud, including the False Claims Act (31 U.S.C. Sections 3729–3733), the Physician Self-Referral Law (42 U.S.C. Section 1395nn), and the Anti-Kickback Statute (42 U.S.C. Section 1320a–7b[b]). However, the primary criminal law dealing with health care fraud is found in 18 U.S.C. Section 1347.

Under the federal health care fraud statute, it is a crime to knowingly and intentionally defraud or attempt to defraud any health care benefit program. It is also a crime to fraudulently obtain the money or property of a health care benefit program through misrepresentation and false claims.

Committing health care fraud or Medicare fraud is a felony crime that carries a maximum sentence of 10 years in prison. However, if the crime results in injury or death to the patient, the penalties upon conviction are greatly increased.

If a patient is seriously harmed during an unnecessary procedure performed with the intent of defrauding a health care benefits program, the provider would be charged with health care fraud resulting in great bodily injury. This offense is punishable by a maximum of 20 years in prison. If the patient dies as a result of a healthcare practitioner’s attempt to commit fraud, the crime carries a maximum sentence of life in prison.

DC Federal Criminal Defense: Health Care Fraud Attorney

The Centers for Medicare and Medicaid Services (CMS) is headquartered in Baltimore and Washington, DC. With Medicare fraud hitting so close to home, and with federal agencies close by to investigate suspected fraud, prosecution in a DC health care fraud case is swift and forceful. Consulting with a dedicated DC federal criminal defense attorney, one who has experience with federal health care fraud cases, is your best option for protecting your legal rights.