Health Care Fraud
Alexandria Health Care Fraud Attorney for Medical Practitioners and Patients
Health care costs have skyrocketed in the United States, including medical care and insurance rates. Furthermore, the insurance industry remains unsettled as lawmakers propose wildly differing legislation about how to curb the costs and insure patients. Amidst this volatile atmosphere, law enforcement has focused its efforts on the conduct of medical professionals and companies. In July 2017, the U.S. Department of Justice charged 412 people, including 50 doctors, in 20 states with health care fraud amounting to $1.3 billion. The prospect of getting caught in this web is frightening. An error can lead to expensive, time-consuming and stressful investigation of patients’ records and a practice’s accounting books. Charges can tarnish a practice’s reputation and ruin a doctor’s career. Binnall Law Group defends practices and doctors who are targeted by law enforcement. If retained during the early stages of an investigation, an Alexandria health care fraud attorney can often help clients avoid charges and prevent disclosure of confidential or incriminating information. We also defend doctors whose licenses are at risk.
What is Health Care Fraud?
Health care fraud describes a number of crimes involving unlawful practices for the purposes of financial gain. Common fraud charges an Alexandria health care fraud attorney handles include:
- Upcoding. Doctors use an insurance billing code for a more expensive service or medical device than they provided to the patient.
- Double billing. Doctors charge for an item or service twice, sometimes billing both the insurance company and the patient for the same service or medical product.
- Billing for services or goods not provided. Doctors bill the insurance company for services they did not render or goods the patient did not purchase.
- Unbundling. Certain medical procedures bundle services together that are more expensive if charged individually.
- Receiving kickbacks. A doctor may receive money or gifts from a pharmaceutical or medical device company for using or recommending its products.
- Recommending unnecessary services. A doctor may be held liable for rending unnecessary services to a patient to make more money.
- Running a pill mill. Law enforcement has targeted clinics that prescribe high levels of narcotics, often ensnaring innocent pain clinics that provide quality care to sick and injured patients.
It’s important to note that healthcare fraud requires:
- Intentionality or knowledge; and
- For the purpose of financial gain.
If you can demonstrate that your “fraudulent” conduct was in fact mere negligence, then you can avoid criminal liability altogether. Even if you intentionally recommended excessive and unnecessary treatment, for example, you can avoid criminal liability so long as your Alexandria health care fraud attorney can show that the purpose of your conduct was not to derive financial gain.
What Should a Doctor or Clinic Do if Suspected of Fraud?
Law enforcement does not generally have a right to documents without a warrant or subpoena. Even if armed with a warrant, doctor-patient privilege may prevent disclosure of sensitive information. In addition, agents cannot compel a suspect to give a statement that may be incriminating. We recommend that doctors and clinics contact our experienced white-collar criminal defense attorney before making any statement or turning over any document to state or federal police or prosecutors.
Contact an Experienced Alexandria Health Care Fraud Attorney for White Collar Criminal Defense Assistance
At Binall Law Group, we have extensive experience representing white collar criminal defendants in a range of disputes, including those that involve allegations of healthcare fraud. Over the years, we have substantial success navigating the complex set of regulations that define healthcare fraud and have helped clients avoid criminal liability. Call (703) 888-1943 or request an appointment online to speak to an experienced Alexandria health care fraud attorney today.