Federal Healthcare Fraud Charges

What Are The Different Federal Healthcare Offenses An Individual Can Be Charged With?

There is a specific statute in the United States Code defining healthcare fraud and that will be one that is most often pursued against any individual who is charged with federal health care fraud. In addition, the government typically seeks charges for conspiracy if more than one person is involved, which is often the situation with health care fraud schemes. In regards to the way the fraud was conducted, the government will also seek charges for wire fraud, mail fraud, or any kind of fraud charges that they can bring in relation to how the government was defrauded.

Thus, charges are typically filed under the healthcare fraud statute, as well as additional fraud counts, additional conspiracy counts, and money laundering counts available to prosecutors. In almost all situations where the underlying healthcare fraud is successful, the the gains from that fraud will need to be concealed, the fraudulent nature of them will need to be concealed, which is why money laundering charges often accompany health care fraud charges.

What Are Some Circumstances Where Someone May Be Charged With Federal Healthcare Fraud?

One recent example was a pharmacy with multiple locations submitting claims to Medicare for medications allegedly dispensed to clients (meaning patients), except the medications were not dispensed at all. In certain cases, medications were dispensed in lower amounts or were substituted for a different medication (a generic for example), but the billing was for the full amount or the far more expensive medication.

In these schemes, what can happen is millions of dollars of alleged medications are being billed to Medicare when in fact they’re not being sent out at all.  In reality, the pharmacy either never had the medications or they do all of the paperwork for the medications and then they send it out and then just simply empty the bottles and redo it again using the same medications—all of which can net millions of dollars of fraudulent gains. That will be one example.

Other examples that I’ve seen include billing for procedures that were either not necessary or not done; for example, a doctor’s office routinely billing for CAT scans that either weren’t done or weren’t required.  In these cases, the paperwork submitted often alleges that it was a medically necessary procedure when in fact it was not. Thus, the office is therefore gaining some reimbursement from Medicare when it absolutely was not necessary and therefore they can increase their revenue.

What Happens Once An Individual Is Formally Charged?

Once an individual is formally charged, they will be arrested, brought to court, processed, informed of what they are charged with, and they will either retain an attorney or have an attorney appointed. Once charges are brought, the individual will be facing mandatory court appearances and the possibility of certain release conditions in certain circumstances depending upon the level of fraud involved and the person’s criminal background, including the possibility that they could be held in custody once they’ve been charged. Once charges are brought, the individual is fully involved in an ongoing federal case, which can be an extremely expensive and stressful situation that can last at least several months. When this happens, individuals need to get legal representation as soon as possible if they have not already done so.

What Should Someone Expect If They Are Facing Healthcare Fraud Charges For The First Time?

Defendants can expect to have all of their records, including financial records, telephone records, electronic records (meaning e-mails, texts, and other electronic communications), and business records, subpoenaed by the government as the government is combing through their affairs.

They can also expect to have law enforcement contact them and seek to have an interview. If they are working in an office or in some kind of business, they can expect to have their co-workers and other people associated with the office or business be interviewed and to be looked at very closely. In sum, they can expect basically to be in the cross hairs of the government and for an intense investigation to happen.

Contact a Federal Defense Attorney

Facing charges like these can be intimidating, but by retaining a DC federal health care fraud attorney, defendants can work to protect themselves from federal charges.  Call our law offices today to learn more about how you can take action.