Healthcare Fraud

Health care is one of the most discussed aspects of life in the United States. The cost of health care has skyrocketed. Congress enacted a massive reform, which is the subject of many legal challenges.

One aspect of the debate concerning health care focuses on supposed fraud associated with providing certain medical services and products. Health care fraud has become a hot topic and has recently become a major focus of law enforcement and prosecutors. The recent health care reform law specifically directed that federal prosecutors look more closely at such cases and bring more prosecutions.

The vast majority of health care fraud cases are prosecuted in federal court. One major reason that most health care prosecutions end up in federal court is because virtually all medical dollars can be traced back to either Medicare, Medicaid or some form of insurance that is offered by companies operating in interstate commerce.

In 18 U.S.C. § 1347 the United States Congress enacted a specific law which outlaws health care fraud. However, in most health care cases the prosecutor also will pile on other federal charges. Such cases routinely include other crimes such as mail fraud, wire fraud, false claims, and money laundering. People often wonder how a doctor can be accused of money laundering when the basic charge is that he or she did some improper billing. The answer is that depositing into or removing money out of a bank can be charged as money laundering if the funds were originally obtained as part of a fraudulent course of action.

There are many varieties of cases that fall under the heading of "health care fraud." Some of the more common types of prosecutions include fraudulent billing, such as billing for services not performed. Other cases involve something known as "upcoding," where the medical practice performs a relatively minor procedure but calls it a more complex matter that is reimbursed at a higher amount. Other cases involve unbundling, the misrepresentation of diagnoses and procedures; or accepting kickbacks for patient referrals. These prosecutions are brought against physician providers, hospitals and clinics, pharmacists, medical billing companies and specialists, durable medical equipment companies, and even patients. People involved with online pharmacy websites can also be at risk of criminal prosecution.

Health care fraud cases are remarkably intricate and complicated. It is very common for these types of cases to involve massive quantities of computergenerated evidence. Lawyers often need to hire experts to understand and retrieve the evidence. Furthermore, such cases generally involve a large number of potential witnesses. The attorneys handling such matters need to be wellversed in all aspects of defending a federal criminal case.

In addition to being very complicated, health care prosecutions and convictions also can have serious consequences for a person accused of such a crime. Not only is he or she facing possible incarceration, they also could have significant fines or restitution imposed by a judge. Sometimes the worst thing that can happen at the end of a health care prosecution is that the medical professional might possibly lose his or her right to practice in the medical industry.

Defending against a federal health care prosecution requires significant investigation, document review and analysis of the materials in the Government's possession. Quite often, a good criminal defense attorney will want to use his or her own experts when defending against health care fraud allegations.

At Kish & Lietz, we regularly handle complex health care fraud prosecutions. We are accustomed to handling the massive number of documents involved in these cases. We hire our own specialists when we defend our clients, trained professionals such as accountants, auditors, retired FBI agents and the like. Our attorneys are accomplished, aggressive, and prepared to handle these challenging cases. If you would like to talk with us about such a case, please feel free to call us at (404) 588-3991, or contact us online.