Healthcare Fraud

Healthcare fraud can materialize as either or both a state crime or a federal crime. In most circumstances, it is a federal crime but that is dependent on a number of factors. Either way, if you are charged with healthcare fraud or related crimes like insurance fraud, the penalties can be serious. You need a criminal defense attorney who knows the law inside and out and is able to identify key facts to help your case.

S.L. England, a reputable criminal defense attorney representing clients throughout the District of Columbia and Virginia, has the skills and insight to uphold your rights before a judge and jury and hold the prosecutor accountable to the principle that you are innocent until proven guilty beyond a reasonable doubt. Contact S.L. England’s law office today to learn more about his approach to criminal defense and your options to defend against healthcare fraud allegations.

WHAT IS CONSIDERED HEALTHCARE FRAUD IN VIRGINIA AND THE DISTRICT OF COLUMBIA?

No matter which jurisdiction you are in, healthcare fraud is defined comparatively the same. In basic terms, healthcare fraud occurs when a person or entity files a health care claim with the intent to profit or benefit from the claim. The crime is charged as insurance fraud if the fraud is committed against a private carrier.

The alleged offender of healthcare fraud can be:

  • a medical institution or facility
  • a medical provider (e.g., general practitioner, dentist, surgeon, etc.)
  • a patient
  • health insurer.

In Virginia, these crimes are typically charged as white-collar felony theft. When the allegation is under federal jurisdiction, it is classified as a federal felony. Most federal healthcare fraud claims are related to Medicare and Medicaid abuse.

Typically this crime involves the alleged offender devising a plan or scheme to provide healthcare-related falsehoods with the goal of financial gain. As such, the requisite mental state involves knowingly and willingly engaging in fraudulent healthcare activities.

A prosecutor must prove the mental state along with all the elements of the alleged crime. Minus proof of the mental state, it will be hard to get obtain a conviction.

WHAT ARE EXAMPLES OF HEALTHCARE FRAUD IN THE D.C./VIRGINIA METRO AREA?

To better understand what healthcare fraud entails, examples are provided below.

  • A patient fakes a medical condition to receive certain medications that he or she then sells.
  • A patient falsifies information on a medical claim. 
  • A patient gets healthcare service by using someone’s else’s insurance.
  • A medical provider may bill for goods or services that were never provided, like x-rays, lab tests, or medicine.
  • A medical provider may upcode medical procedures by, for example, increasing time spent with the patient or stating the provided service was more labor-intensive than it actually was.
  • A doctor may split fees in return for things like rent or cash payments in what’s known as paying “kickbacks.”
  • A provider, like a Medicaid van or taxi company, may inflate claimed mileage or bills for services provided.
  • A provider bay double bill, i.e., it obtains payment for one service from two sources.

HOW CAN YOU DEFEND AGAINST HEALTHCARE FRAUD ALLEGATIONS? 

There are defenses to healthcare fraud allegations. These may include things like:

  • mistake of fact
  • mistake of identify
  • lack of intent or willingness.

It is important to identify if each individual case is one that truly involved healthcare fraud or one where honest billing errors, mistakes, or omissions were made. In either case, you still have the right to defend yourself. Depending on the facts, circumstances, and evidence, S.L. England will devise a defense strategy aimed at getting the best outcome for you.  

WHAT ARE THE PENALTIES IF CONVICTED OF HEALTHCARE FRAUD IN VIRGINIA OR THE DISTRICT OF COLUMBIA?

A good defense is necessary in any healthcare fraud case. The State of Virginia, the District of Columbia, or the federal government – in whichever jurisdiction your case is filed – the prosecutor will use the full force of the office to get a conviction.

And should you be convicted, you can expect:

  • prison (in some cases, you could be looking at up to 20 years in prison regardless of the jurisdiction);
  • fines (in some cases, you can anticipate as an individual convicted of a federal crime, fines of up to $250,000, or if the conviction is a state offense, fines of up to $2,500)
  • restitution (federal and state courts can order you to pay back the monies you have been convicted of improperly obtaining via healthcare fraud); and/or
  • probation or parole (these programs may be the result of a reduced sentence but still restrict your freedoms and require that you abide by strict terms and conditions or risk going to prison).

You can also expect a potential civil lawsuit filed against you. If the petitioner is successful, you can be ordered to pay fines, restitution, and possibly punitive damages.

GET THE HEALTHCARE FRAUD DEFENSE YOU NEED IN D.C. OR VIRGINIA: CONTACT S.L. ENGLAND, PLLC TODAY

Allegations of healthcare fraud for a provider or any other person can be embarrassing and can hurt a person’s reputation and professional business. It is important to seek smart, strategic legal representation as soon as possible to avoid the collateral consequences of an arrest or allegation and to fight against a conviction.

Contact S.L. England online or at 202-489-0720 today to get started on your defense today.

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