Houston Healthcare Fraud Attorney

Federal Health Care Fraud Attorney – 18 U.S.C. § 1347

With the rapidly increasing prevalence of healthcare fraud, many healthcare providers face lawsuits – or, in severe cases, federal charges of healthcare fraud.

Hiring an experienced and skilled healthcare fraud lawyer is essential if a healthcare provider is accused of fraud. Charges related to healthcare fraud can put your business and professional reputation at risk and even result in losing your medical license, fines, or prison time. Many individuals are surprised to learn that federal healthcare fraud is widespread, but it occurs so regularly that the F.B.I. shares daily updates on new and ongoing healthcare fraud investigations.

Federal healthcare fraud can encompass many allegations, and prosecutors can pursue criminal charges related to different federal statutes. If you are the national healthcare fraud investigation target, you must act swiftly to protect yourself.

What are Healthcare & Medicare Fraud Charges?

Health care fraud is an intentional attempt to deceive or misrepresent medical claims to a health care benefit program or the government. It can be attributed to a variety of supposed motivations. 

Healthcare fraud charges are commonly based on allegations against a healthcare practitioner, clinic, or another provider that issues licenses for goods/services that were either not medically necessary or not provided. Most healthcare fraud cases involve false bills submitted to private insurance companies, Medicare, Medicaid, or TRICARE.

However, there are also instances in which fraud charges originate from whistleblowers (such as patients, office staff, former business partners, or competitors) reporting illegal activity.

Types of Healthcare & Medicare Fraud

Many examples of healthcare fraud offenses can be tried in a federal court of law. Below, we’ve provided a brief list of some of the most common, including some civil crimes that can be added to federal charges. It is not unusual for federal prosecutors to pursue criminal and civil charges.

Examples of healthcare fraud include:

• Misrepresenting diagnoses/procedures to receive maximum payments
• Falsifying claims
• Upcoding/unbundling
• Unlawful prescribing/dispensing
• Falsifying medical necessity (certificates) to bill unwarranted services
• Falsifying treatment plans/medical records to justify payment requests
• Requesting “kickbacks” for various services/goods

When you partner with lawyers at the Law Office of SKJ, you can be confident that you will be provided an aggressive defense by one of our highly skilled Houston healthcare fraud attorneys. We have extensive experience defending individuals and businesses charged with federal healthcare fraud and possess the knowledge and determination to provide effective legal representation in court. 

Defraud a Healthcare Benefit Program

As per federal statute 18 U.S.C. § 1347, it is a crime to intentionally defraud any health care benefit program or obtain payments under fraudulent claims. Intent is a critical factor in all federal healthcare fraud charges. 

Prosecutors use various methods to illustrate a defendant’s “intent,” generally pointing to false promises, pretenses, or misrepresentations used to gain money/services to which the individual would otherwise not be entitled. 

It is vital to understand that knowing the illegality of your conduct is not a requirement for conviction. This means that even if you are unaware that your actions are illegal under federal law, you can be declared guilty if a prosecutor successfully proves your supposed intent. 

Healthcare & Medicare Fraud Investigations

If you are accused of healthcare fraud, you may not always be aware of the exact reason for the investigation. It is not unusual for healthcare providers to be confused after learning they are the target of a federal government investigation because they believe their conduct has adhered to all regulations. Other providers falsely assume that federal prosecutors are only interested in high-dollar healthcare fraud schemes, but that is false.

The sharp increase in fraud has led to substantial growth in federal government investigations. Furthermore, technological advancements have made it easier for federal agencies to pinpoint and target suspicious billing activity for healthcare services. 

Everyday Fraudulent Activity in a Healthcare Investigation

You are not alone if you are a medical provider who is the target of a criminal investigation. At the federal level, agents are highly experienced in identifying healthcare fraud, particularly when activity is flagged for its similarity to standard forms of healthcare fraud.

Some of the most common activities to initiate a federal healthcare fraud investigation include:

Everyday Fraudulent Activity:

• Falsifying patient records
• Billing for services that were not provided
• Accepting or soliciting referral fees
• Billing services individually rather than bundling them as required
• Inaccurate billing
• Double billing a federal insurance benefits program
• Billing for unnecessary medical services
• Submitting false information to a federal agency

If you are under investigation for healthcare fraud, you should take immediate action and secure an experienced criminal defense attorney to safeguard your rights. Should you need a highly adept healthcare fraud lawyer, the Lawyers at SKJM are prepared to come to your defense. We defend individuals and companies charged with a diverse range of fraud and abuse violations, including:

• Medicare fraud
• Medicaid fraud
• Medical billing fraud
• Federal Health insurance fraud
• False Claims Act
• Anti-Kickback Statute
• Stark Law
• Controlled Substances Act

Potential Penalties and Sentences for Healthcare Fraud

Violating 18 U.S.C. § 1347 is punishable by a fine of up to 10 years in federal prison, with potential penalties for healthcare fraud increased to 20 years if an individual experienced severe bodily harm as a result. If you are charged with fraudulent actions resulting in a fatality, you can face a life sentence.

Healthcare Fraud Conspiracy – 18 U.S.C. § 1349

Under 18 U.S.C. § 1349, federal healthcare fraud can be elevated to a conspiracy charge if one or more people agree to commit fraud together. This situation can occur in many forms, from relatively simple to highly complex. Prosecutors will work to prove that every involved party was aware of the fraudulent nature of their activity.

Conspiracy to commit healthcare fraud can come with severe penalties of 10, 20, or even life in federal prison, depending on the outcomes of the crime committed.

How our Texas Healthcare Fraud Defense Attorneys Can Help

A charge for federal health care fraud should be taken very seriously at an individual and company level. If you have been accused of committing federal healthcare fraud, there is no time to waste: contact our experienced healthcare fraud defense attorneys in Houston now.

In some cases, resolving a criminal charge without going to trial is possible. You may even be able to stop payments from being filed altogether. However, these outcomes require prompt action and a healthcare fraud lawyer with the necessary skills to navigate the details of your situation rapidly. We aim to protect your rights at every stage, even at the earliest sign of an investigation. From negotiating a pre-indictment resolution to litigating your case in a federal jury trial, you need the Law Offices of SKJ.

Contact our Houston federal healthcare fraud defense lawyers to schedule a consultation today. Call 713-228-8500