In June 2024, the US Department of Justice (DOJ) revealed charges against 193 defendants, including 76 licensed medical professionals, spread across 32 federal districts. These individuals were involved in plans resulting in approximately $2.75 billion in intended losses and $1.6 billion in actual losses to healthcare programs.
Healthcare fraud charges can have serious legal, financial, and professional consequences. These accusations typically involve willfully lying to obtain unapproved Medicare, Medicaid, or private insurance benefits.
A defense lawyer can help individuals who are facing these types of charges. Healthcare fraud attorney Michael R. Bartish states that healthcare fraud is complex and involves the understanding of insurance and healthcare rules and policies, along with white-collar crime laws. If you want the legal process to go as smoothly as possible, you should work with a lawyer who has handled similar cases before.
A skilled attorney will investigate the specifics of the case, protect the accused’s rights, and devise a tactical defense that accurately reflects the situation. This article will go over the main healthcare fraud defenses used by lawyers and their legal foundations.
Understanding Healthcare Fraud Charges
Healthcare fraud refers to the act of charging for services or treatments that are not actually provided or are misrepresented.
If you are charged with healthcare fraud, it is critical that you know the specifics of the charges brought against you. Healthcare fraud carries severe penalties, including civil penalties, imprisonment, massive fines, and loss of medical license.
Depending on the situation, healthcare fraud charges can result in you facing civil suits or losing your medical license.
Knowledge of what constitutes healthcare fraud helps protect your interests.
The Role of Investigation in Defense
Understanding the white-collar crimes, such as healthcare fraud, provides guidance for your defense, but a strong investigation bolsters this defense.
Mesa criminal defense attorney David Lish says obtaining legal counsel helps reduce the impact of criminal charges on your life. Early legal advice can help you completely avoid legal action.
Evidence that supports your case and counters prosecution claims must be gathered. Medical records and other documentation may be relevant, including billing practices and any related communications that address the allegations.
Interviews with witnesses can support your argument. Forensic accountants or investigators could discover mistakes or inconsistencies to clear the accusations against you. A thorough investigation strengthens your case, clarifies facts, and demonstrates honesty and integrity.
Legal Strategies for Challenging Charges
There are specific legal strategies that can be used to tackle healthcare fraud charges.
Take a look at the evidence against you. Scrutinize all documents, billing records, and witness statements to find any inconsistencies or inaccuracies.
File pre-trial motions to dismiss charges that have insufficient evidence or procedural irregularities. Engaging the services of an expert witness further strengthens your case and provides a professional perspective to contest the prosecutor’s account of events.
Negotiating with the prosecution may allow you to receive a reduced charge or resolve the situation through an alternative solution.
Communicate closely with your attorney. Collaborating with your lawyer keeps you informed and involved in your defense strategy.
Demonstrating Lack of Intent
The demonstration of lack of intent is critical in defending against health fraud charges. Showing that you have no intention of committing healthcare fraud can significantly weaken the prosecution’s case.
To successfully use this legal defense strategy, you must present evidence that the alleged fraudulent actions were unintentional. Your proof may include documentation of the usual protocols followed in the training and compliance you practiced. You might also emphasize any of the misunderstandings or misinterpretations that brought on the charges.
Negotiating Plea Deals and Outcomes
During the negotiations with the prosecutors, a lawyer will push for reduced charges, a lesser penalty, or even an alternative sentence. Keep in mind that a plea agreement may relieve you of the overall negative effects of healthcare fraud on your career and reputation, making it much easier to move on.
An attorney will gather evidence to present your case and mitigating factors to persuade the prosecutors to accept your plea bargain. Entering into a plea bargain is frequently interpreted as an admission of guilt, but it can save you from the uncertainty of a trial and provide a more predictable outcome for your future.
MindOwl Founder – My own struggles in life have led me to this path of understanding the human condition. I graduated with a bachelor’s degree in philosophy before completing a master’s degree in psychology at Regent’s University London. I then completed a postgraduate diploma in philosophical counselling before being trained in ACT (Acceptance and commitment therapy).
I’ve spent the last eight years studying the encounter of meditative practices with modern psychology.