The government takes a harsh stance on medical fraud, also known as healthcare fraud. The laws pertaining to healthcare fraud are complex, and it is important that anyone involved in billing at your practice understands the penalties associated with white-collar crime and how to avoid it. Medical fraud attorneys can provide detailed information for practices looking to take preventative measures against healthcare fraud charges.
7 Questions to Ask a Medical Fraud Lawyer
1. What Is Healthcare Fraud?
Healthcare fraud is a financially motivated crime involving fraudulent billing for medical services. A provider might bill for a service he or she did not actually provide, or he or she might order and bill for a service that was not medically necessary. More subtle forms of healthcare fraud include double billing for services and billing for services that were more expensive than the ones the patient received.
Healthcare fraud can involve bills submitted for medical services, diagnostic tests, prescription medications, and/or medical supplies. Any type of medical facility can be the subject of a healthcare fraud investigation, including dental practices and even pharmacies.
2. What Are the Penalties for Healthcare Fraud?
Being convicted of healthcare fraud can have serious consequences for you and your practice. The potential penalties include heavy fines, jail time, professional sanctions, and other collateral consequences. The severity of the penalties usually depends on whether or not the care of any patients was compromised, the scale of the fraudulent operations, and the amount of money involved.
3. How Does the Government Find Out About Healthcare Fraud?
All healthcare facilities and their providers are subject to randomized audits that are done to catch fraudulent activities. If the auditors see discrepancies between a facility’s activities and standard billing practices, they will initiate an FBI investigation.
Another way in which the government could find out about fraudulent billing is if someone from inside the healthcare facility reports it. Medicare is frequently the target of billing schemes, and the Medicare website actively encourages individuals who are aware of fraudulent activity to report it over the phone.
4. What Should I Do If I Am the Subject of an Audit?
In many cases, simply providing the auditors with access to the information they need will allow your practice to pass the audit without incurring an investigation. Consulting with a Houston medical fraud lawyer can help ensure that you comply fully and meet all of your legal requirements.
5. What Should I Do If the FBI Investigates My Practice?
If the FBI chooses to investigate your practice, you will need to handle the situation delicately, taking care that you do not violate any federal obstruction of justice statutes or give the agents any grounds to argue that your actions inhibited their investigation. Your staff should also be aware of the laws pertaining to federal investigations. At this stage, it is extremely important to work with an attorney who has extensive knowledge of white-collar crimes and healthcare law.
6. How Can I Avoid Formal Charges?
Taking preventative measures to educate yourself and your staff on healthcare fraud and making sure that your billing methods comply with government regulations are the best ways to protect yourself against healthcare fraud charges. While changing a medical code here and there can feel like a subtle act that will go unnoticed, everyone involved in billing at your facility needs to be aware that healthcare fraud can result in an FBI investigation and criminal charges.
If you have already been the subject of an investigation, your lawyer can step in to negotiate with the government on your behalf. By reaching a settlement, you may be able to resolve the issue without formal charges.
7. How Do Medical Fraud Attorneys Fight Their Clients’ Charges in Court?
Even if you must go to court after being accused of medical fraud, you may have more viable defense strategies than you think. The government does not have any guarantee that the evidence against you will hold up, and your lawyer may be able to cast doubt on the credibility of key witnesses, especially if a medical expert testified that the services you provided were not necessary.
Additionally, your lawyer may be able to prove that the statutes you violated were not clear, or that the government provided guidelines that contradicted one another. These are just some of the strategies that have been successfully used to help individuals who were accused of medical fraud avoid conviction.
Whether you are preparing for a routine audit or facing accusations of a major white-collar crime scheme, understanding the laws pertaining to healthcare fraud is essential. By talking with a healthcare fraud attorney, you can learn what steps to take to avoid formal charges, and how to fight them if you must appear in court.