Healthcare Fraud

What is Health Care Fraud?

Health care fraud covers a variety of frauds in the health care field.

Billing Frauds

Some of the most common health care fraud schemes include:

1. Billing for services not rendered;
2. Up-coding of services (i.e., billing for a more expensive service than the one actually provided);
3. Up-coding of items (e.g., billing for a motorized wheelchair when only a manually propelled chair was provided);
4. Duplicate claims for a single service;
5. Unbundling
   • (i.e., submitting bills in a fragmented fashion in order to maximize the reimbursement for various tests or procedures that are to be billed together at a reduced cost);
6. Excessive services (services in excess of the patient’s actual needs); and,
7. Medically unnecessary services (services not justified by the patient’s medical condition).

Other Crimes Related to Health Care Fraud

Health care fraud prosecutions often include charges for additional white-collar crimes that are committed within the health care industry, such as paying or receiving kickbacks, identity theft by employees who have access to electronic health records (EHR), wire and mail fraud, and money laundering.

Who is Being Prosecuted for Health Care Fraud?

How Common Are Health Care Prosecutions?

In 2016 alone, the Department of Justice (DOJ)opened 975 new criminal health care fraud investigations across the United States, in addition to 930 new civil health care fraud investigations and 1,422 civil health care fraud matters. The government spent almost one billion dollars in 2016 to investigate and prosecute health care fraud.

Why do these numbers matter? These numbers matter because it shows that federal law-enforcement is committed to spending significant amounts of time and money to prosecute those it believes have committed some type of health care fraud.

How Tim Anderson Law Can Help

Tim Anderson Law has significant experiencein representing clients who are being investigated of or prosecuted for health care fraud.

The ideal time to retain a criminal defense attorney is at the beginning of any investigation, but it is particularly important to retain counsel if you have been contacted by the FBI, the FDA, or some other health care fraud investigating authority.

If you are under investigation, or if your case has been referred to the U.S. Justice Department or a U.S. Attorney’s Office, you should contact Tim Anderson Law or another experienced federal criminal defense attorney as soon as possible.The earlier we are brought in and can advocate on your behalf, the better your chances of achieving a favorable outcome.

Tim Anderson Law has significant experience in effectively resolving our clients’ casesthrough creative problem-solving, thorough investigation, and adroit negotiation, all to help our clients make the crucial strategic and tactical decisions necessary to navigate complex federal health care fraud cases.

In the end, our strategy is simple: Tim Anderson Law puts our clients first and works doggedly on their behalf.Of course, no attorney can ever guarantee a certain result, but it has been our experience that our work ethic, skill, diligence, and compassion all contribute to maximizing our clients’ chances of receiving an excellent outcome.