Accused of Healthcare Fraud? What to Do

Healthcare fraud charges don’t get much attention in the popular media, but the federal government’s criminal investigators make the detection and prosecution of healthcare fraud one of their top priorities.  


Authorities estimate that Medicare and Medicaid lose more than $100 billion a year in healthcare fraud. Healthcare fraud cases include a wide variety of allegations, often accusing doctors, medical equipment suppliers, therapists, pharmacists, chiropractors, surgeons, and many other kinds of clinicians of being involved in complicated criminal conspiracies. But patients and marketing firms can also be charged with healthcare fraud crimes. 


This article outlines the important steps you can take to maximize the power of your defense in a healthcare fraud case. 


Stechschulte Nell, Attorneys at Law in Tampa, knows how aggressively the government prosecutes individuals and medical practices in healthcare fraud cases. We are experienced criminal defense lawyers who work tirelessly to protect your legal rights when federal law enforcement officers target you for investigation or prosecution. If you have questions about any healthcare fraud-related issues, contact our office for answers and a full case analysis. 




Healthcare Fraud Penalties


Violating federal healthcare fraud statutes can lead to severe criminal and civil penalties. For cases involving fraud that do not involve aggravating circumstances, the baseline penalty is up to 10 years in prison and a $250,000 fine, for each count of the indictment. 


If anyone suffered an injury as a result of the fraudulent scheme, a conviction can result in a sentence of up to 20 years in prison, and more substantial financial penalties. A death could lead to a life sentence. Of course, such convictions would also put an end to a defendant’s medical practice. And those who suffer convictions for reduced charges in federal healthcare fraud cases and serve shorter sentences are typically barred from participating in the operation of any business that bills Medicare or Medicaid following their release from prison. Working in the healthcare sector would be virtually impossible. 


What Should You Do If You Are Accused of Healthcare Fraud?


The first thing you must do is contact an experienced criminal defense lawyer who is fully conversant with federal healthcare fraud law and who practices in federal court regularly. Choosing the right criminal defense lawyer is important and can impact the direction in which your case proceeds.  


An experienced federal criminal defense lawyer will communicate with the government in a meaningful exchange through which you will learn what evidence the prosecution has and what it may be lacking. Your lawyer will also thoroughly analyze the information, documents, and data you provide to identify all material that tends to support your innocence or mitigate your culpability. 


Your attorney will do all the speaking for you. Do not speak with any federal investigators without first speaking with your criminal defense attorney. If you tell investigators the truth, you may incriminate yourself. If you mislead or lie to investigators, you may face a felony charge of lying to federal investigators.  


Preserve All Documentation 


Retain all documentation that could be relevant to the case, such as patient records, billing statements, and correspondence. These documents could serve as crucial evidence to rebut the charges against you. Do not alter, hide, or destroy any material that is relevant to the alleged criminal activity because such conduct will more likely result in additional charges of obstructing justice than it will help to protect you.  


Understand the Nature of the Allegation 


Federal healthcare fraud charges can be brought in situations involving many different scenarios. Here are just a few possible ways in which federal healthcare fraud can be committed:



  • Multiple billing for a single service – double billing. 
  • Billing for service never performed or equipment never supplied – phantom billing. 
  • Billing for portions of a service individually and also as a complete service – unbundling. . 
  • Billing for services that cost more than the service the patient received – upcoding 

Patient Identification Misuse and Identity Theft 


  • Using patient identification information on bills without patient’s knowledge or consent –  
  • Conspiring with patients or patient referral sources to be fed patient information for false billing 
  • Obtaining patient identification information known to be obtained through fraud 
  • Treating and/or billing for services provided to a person using another person’s insurance 
  • Using another person’s insurance card to obtain treatment or prescriptions 
  • Pharmacist knowingly accepting and filling false prescriptions  

Bribery / Kickbacks 


  • Paying or rewarding patients to use them for fraudulent billing 
  • Receiving payment or reward for assisting others in fraudulent healthcare billing 


And there are many other fact patterns in which both public and private insurers are defrauded. 


Effective Defenses to Healthcare Fraud Charges

Lack of Intent 


Fraudulent intent is a key element in healthcare fraud cases. Demonstrating that any inconsistencies or errors were unintentional can serve as a potent defense. Did you bill for services not rendered due to an administrative error? Was the alleged upcoding an honest misunderstanding of billing codes? Establishing a lack of intent could lead to acquittal or dismissal. 


Good Faith 


A good faith defense hinges on the idea that you believed you were operating within the confines of the law. For instance, if you were acting on advice from a legal or medical advisor whom you had no reason to doubt, this could be presented as a good faith misunderstanding. 


Insufficient Evidence 


Often, healthcare fraud cases are built on incomplete or ambiguous evidence. Skilled criminal defesne lawyers will mount a robust defense and will rigorously scrutinize the evidence brought against you, looking for inconsistencies and gaps that can cast doubt on your alleged guilt. 


Statute of Limitations 


There is a legal time limit within which healthcare fraud charges must be brought. If this time frame has lapsed, your attorney can move for the case’s dismissal. 


Federal law requires that any criminal charge for violating the healthcare fraud statute must be commenced by the government within 5 years of the alleged act. (18 U.S.C. § 3282). If a civil complaint is brought against an individual or a business alleging violation of the healthcare fraud laws, the government’s complaint must be filed within 6 years of the alleged misconduct. (42 U.S.C. § 1320a-7a(c)(1)). 


Contact the Experienced Healthcare Fraud Criminal Defense Firm 


Navigating the intricacies of healthcare fraud allegations is a daunting task, with life-altering consequences looming large. But remember, you don’t have to face this challenge alone. Armed with the right information and backed by an experienced legal team, you can mount a compelling defense. If you or someone you know is under scrutiny for healthcare fraud, now is the time to act.  


Don’t wait until it’s too late. Reach out to Stechschulte Nell, Attorneys at Law, today. Our dedicated team is committed to safeguarding your rights, reputation, and future.


Let us stand with you, guide you, and fight fiercely for the best possible outcome. Call us at 813-280-1244. Your future may depend on it. 

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