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Health Care Fraud
Health Care Fraud is a broad phrase that includes Medicare Fraud, Medicaid Fraud, Insurance Fraud and Kickbacks. All are federal crimes. The federal government has made no secret of the fact that it intends to initiate many more health care fraud prosecutions. The government programs that make up Medicare and Medicaid are technical, confusing and full of bureaucratic red tape. The requirements for submitting claims to insurance companies are not much simpler. Upcoding services provided, billing errors and questionable practices, duplicate claims, incorrect reporting of diagnoses or basis for services, coding a non-covered service as a covered service and providing unnecessary services can all be federal crimes.
Referring patients to providers that the health care professional has an interest in, obtaining referral fees and receiving money or valuable perks from medical equipment suppliers or prescription drug companies can also be federal crimes. In the complex and technical world of health care reimbursement, errors are going to occur. Whether these errors are honest mistakes or intentional fraud is almost always the issue in criminal health care fraud cases. Proving that a person knew or should have known that that the questionable conduct was occurring and was being done to obtain something they were not entitled to as opposed to honest mistakes, misunderstanding of the reimbursement codes or procedures or mismanagement is almost always the question in health care fraud cases.
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A lawyer knowledgeable and experienced in this area can help resolve issues in the best way possible.
The consequences of a conviction for health care fraud are severe. Not only will the government seek jail time and fines but a conviction may also result in the loss of your license to practice and/or the loss of your ability to participate in and obtain reimbursement from federal programs.
A person under investigation for health care fraud needs to consult with a white collar criminal defense lawyer as early in the process as possible to conduct a complete review of the facts and circumstances surrounding the investigation and to determine who is being investigated and whether an early resolution is possible.
Have Questions? Call us at (515) 246-5884