What is Health Care Fraud?
Health care fraud covers a variety of frauds in the health care field.
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;
- (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?
Ambulance & Healthcare Transportation Companies
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Diagnostic Services Companies
The owners and employees of these companies have been prosecuted for health care fraud and conspiracy to commit health care fraud for fraudulently billing unnecessary urine screens and submitting inflated bills to Medicare, in addition to other health care fraud-related white-collar crimes such wire and mail fraud, aggravated identity theft, and money laundering.
Dietary Supplement Distributors
Small-business owners who distribute dietary supplements can face charges of illegally selling mislabeled prescription drugs, introducing misbranded drugs into interstate commerce, and possession with intent to distribute controlled dangerous substances, among other similar charges.
In particular, doctors are often the target of federal health care fraud criminal investigations and prosecutions.
In our experience at Tim Anderson Law, we have seen doctors prosecuted for health care frauds including billing for alleged medically unneccesary services, alleged overbilling for unnecessary tests or procedures, prescribing drugs outside accepted medical practice, referring patients for unnecessary products or services, money laundering, unlawful distribution of controlled dangerous substances, and receipt of kickbacks.
Durable Medical Equipment (DME)
The owners and, sometimes, employees, of these companies, have been prosecuted for submitting fraudulent bills, health care fraud-related identity theft, paying and receiving kickbacks, forging prescriptions and documents in support of fraudulent bills, and wire and mail fraud.
The owners of health care clinics have been prosecuted for health care fraud-related identity theft, false billing practices, and money laundering.
Home Healthcare Providers
The owners of companies that provide home health care services have been prosecuted for crimes such as paying kickbacks or submitting bills for services that were never provided or not medically necessary. Nurses and other caregivers for some of these companies have been prosecuted for submitting false patient information and falsifying records in support of fraudulent billing.
Medical Device Manufacturers
The owners of these companies have been targeted in civil and criminal investigations and prosecutions related to failing to obtain FDA approval of their devices, as well as fraudulent billing practices.
The owners of pharmacies have been prosecuted for submitting fraudulent bills to Medicare, paying kickbacks, unlawfully selling oxycodone (accused of operating a “pill mill”) or dispensing misbranded prescription medication. Employees and sales reps have also been prosecuted for crimes related to compounding prescription drugs, including schemes where doctors are paid to prescribe very expensive compound medications without any actual medical necessity.
Pharmaceutical reps, blood testing lab employees, doctors, and others – accused of paying kickbacks to doctors and other health care professionals in exchange for the doctors writing prescriptions for their products and services, or referring patients to obtain those products or services.
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 experience in 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’ cases through 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.