State Bar of Texas
Texas Criminal Defense Lawyers Association
Dallas Criminal Defense Lawyers Association

Federal Healthcare Fraud

The federal government continues to focus more resources towards the prosecution of fraud involving federal health care programs. Not only do the federal healthcare fraud statutes cover government health benefit plans such as Medicare, Medicaid and TriCare, private healthcare benefit programs are likewise covered by the federal healthcare fraud statutes. Investigations of healthcare professionals may arise from whistleblowers or from billing audits run by third party administrators or government agencies. Healthcare fraud is investigated not only by expert agents from HHS-OIG, but frequently by fraud investigators with the FBI. It is also not unusual for federal agents to team up with state investigators for a joint investigation. Frequently, a doctor may be contacted by the government and be requested to explain the physician’s billing practices. Don’t think you can talk your way out of trouble without first consulting a federal healthcare fraud lawyer. Better the government agents walk away frustrated than you leave with them in handcuffs. If you know you are being investigated, don’t wait, contact an attorney. Your freedom, your reputation, your license to practice medicine is at stake. Federal healthcare fraud statutes are not just aimed at doctors, office staff and billing coordinators can and are prosecuted too. Medical equipment suppliers and laboratories are also subject to the federal healthcare fraud statutes.

As a general rule, whenever a profit motive supersedes a patient’s medical needs, legal problems are not usually far behind. The use of recruiters for Medicare and Medicaid patients can be problematic. Referral fees based on a percentage of the billing of Medicare or Medicaid can lead to legal challenges from the government under the anti-kickback statutes. Of course, the billing of services not rendered or for unnecessary durable medical equipment will lead to legal problems with the federal government. What may start off as a simple audit by Medicare or Medicaid, could ultimately result in a criminal referral to law enforcement. Someone accused of diverting taxpayer funds dedicated to the well- being of the impoverished or elderly better have a good defense.

If someone has acquired an attorney prior to indictment, it can be very beneficial to an individual under investigation. An attorney would have an early opportunity to consult with you and even meet with the investigating agents or federal prosecutor about your case to find out in detail their accusations. This would also provide your attorney the opportunity to clarify any misconceptions by the government on your behalf and perhaps dissuade the government from pursuing a criminal case against you. If you are charged, an attorney may be able to work out with the government your voluntary surrender to the investigating agency or Marshals service, in lieu of being arrested in front of your family or at the office.

If an accused is charged with a federal healthcare fraud crime, either individually or part of a conspiracy, the government may seek to detain the accused pending trial or other disposition of the case. The government would have to show that the accused is a flight risk or a continuing danger to society. That would require a case agent to testify in front of a magistrate about the substance of the government’s case. The agent would then be subject to cross examination by the defense. A family member or close friend could then testify to rebut the government’s desire for detention. The accused typically does not testify at this hearing and thereby be subject to cross examination. It certainly is not out of the realm of possibilities for a government prosecutor to be overzealous in their attempt to detain prior to trial. I had a physician client turn himself in, after a failed attempt to arrest him at his home. While in court for his initial appearance, a spectator in the gallery had a seizure and my client went over to the person’s aid. The government still insisted on detainment. The magistrate, however, released my client pending trial. Just don’t go it alone in the initial stages.

Contact Howard Blackmon for a consultation. Don’t wait to be charged. Sometimes sloppy billing may appear to be intentional criminal activity rather than accidental or innocent behavior. You need an experienced heathcare fraud defense attorney to help you. I’ve come at federal healthcare fraud from both sides, as a former federal prosecutor to now defending healthcare professionals.

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