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The Government Is Coming After Health Care Providers

The Department of Justice and Department of Health and Human Services have announced a massive joint effort to prosecute health care fraud. The press release details an indictment against fifty-three people across the country.

And there is other health care fraud news around the country. Just today, a surgeon was charged in New Jersey, and a doctor who runs three clinics was indicted in Illinois. Last week, forty-two people were arrested in California on health care fraud charges. Health care fraud is a hot law enforcement priority.

I’ve represented people being investigated for health care fraud charges, and I’ve represented people charged with crimes related to health care fraud. These prosecutions and investigations are tricky for defense lawyers. They routinely require defense counsel to investigate the details of Medicare regulations in order to effectively represent their clients.

In addition to focusing on the specific regulations at issue, one good thing to look at is what evidence of fraudulent intent is there. I have found that not infrequently law enforcement agents, even federal law enforcement agents, focus on whether a statement on a form is true or false, without focusing on whether the person made the statement with the specific intent to defraud.

Obviously, a crucial part of this is how forms are processed in a health care provider’s office. A carefully crafted claims process may be the best defense that a health care professional has against a criminal charge. Conversely, a process for filing Medicare claims that is sloppy or, worse, absent, can make a defense lawyer’s job harder.

If you have questions about how federal criminal charges are different than state criminal charges, please visit this page on Maryland federal criminal charges or Washington DC federal criminal charges.