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How a Criminal Defense Attorney can Help Win a Healthcare Fraud Case

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Healthcare fraud is a serious crime, and it’s best to talk with a criminal defense attorney to understand the next steps in your case. According to the FBI, healthcare fraud results in losses of many billions of dollars per year, which affects both individuals and businesses. It can lead to higher taxes, higher health insurance premiums, and even exposure to unneeded medical procedures.

Anyone, including doctors and patients, who defrauds the healthcare system for personal gain might be found guilty of health care fraud.

The Florida statutes define fraud as, the “intentional deception or misrepresentation made by a person with the knowledge that the deception results in unauthorized benefit to herself or himself or another person.”

Fraud is any instance of willful and serious misrepresentation with the goal of gaining some form of financial benefit. Insurance companies, such as Medicare, Medicaid, Tricare, and Blue Cross Blue Shield are the target of the deception in healthcare fraud.

Healthcare Providers Committing Fraud

The Florida Statute section 456.0635 prevents healthcare providers from committing healthcare fraud. Those who hold medical licenses in Florida and commit fraud are at risk of losing their license and being prohibited from practicing in the state.

Healthcare fraud is when medical professionals, patients, or others willingly deceive the system by taking unlawful payments or take money that was meant to go toward medical benefit programs.

Here are some examples of fraud:

  • Billing for services not performed.
  • The practice of billing for a service that is not covered as if it were covered.
  • Falsifying the dates of the services provided.
  • Providing false information about the locations of service.
  • Falsely identifying the source of the service.
  • a reduction or elimination of copayments and/or deductibles.
  • Reporting errors concerning diagnoses or treatments (includes unbundling).
  • An excessive consumption of the provided services.
  • Corruption (kickbacks and bribery) (kickbacks and bribery).
  • Issuing prescription drugs in error or when it is not essential.

When a claim is made for reimbursement of services that were not medically necessary, not conducted, overbilled, or not allowable, the person or entity that caused the bill to be submitted can be prosecuted for fraud. This applies to both the person who caused the bill to be submitted as well as the entity that caused the bill to be submitted.

Fines and time spent behind bars are typically the results of being found guilty of healthcare fraud. They are both dependent on the seriousness of the allegations of fraud. The federal government classifies fraud as a felony that can result in a sentence of up to ten years in jail. However, if the deception caused substantial injury to a person, the term could be increased to twenty years in prison. The amounts of the fines can be rather high. They might range anywhere from $10,000 to $50,000 per fraudulent healthcare practice accusation.

If a medical provider is found guilty of fraud, they may be required to surrender their medical license and will never again have the opportunity to earn the privilege of regaining it.

Possible Defenses to Healthcare Fraud

Every investigation and prosecution of healthcare fraud is unique. Having said that, a wide range of defenses have a chance of succeeding in a significant number of situations.

Lack of purpose is frequently used as a legal defense and ranks among the most prevalent of all defenses. To commit fraud is by definition to commit a crime of intent. After all, a billing disparity that occurs accidentally is nothing more than an accident. This is because billing discrepancies are rare. Making a mistake is not the same thing as committing fraud. Even though fraud has taken place, the defendant may still be able to use this defense if they were uninformed of what they were getting involved in at the time.

The alleged victim gave consent. If the person accusing you of committing healthcare fraud gave you consent for your actions, you might not be charged with fraud. You must have proof that consent was given.

No sufficient evidence. The prosecution must be able to prove beyond a reasonable doubt that you willfully committed fraud. If there’s some evidence that the fraud was accidental or you committed fraud unknowingly, you could use that as a defense in your case.

What to Do if Facing Accusations of Healthcare Fraud

You need the assistance of an experienced legal representative if you are accused of committing healthcare fraud or if you fear that you may be the subject of an investigation for Medicare fraud, Medicaid fraud, or insurance fraud. At Hanlon Law, we have a committed team of attorneys that have a history of obtaining acquittals and dismissals for our clients.

Contact Hanlon Law today to schedule a free consultation.

Hanlon Law
1605 Main St Ste 1115
Sarasota, FL 34236
(941) 462-1789

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