Are You Facing a Federal Investigation for Healthcare Fraud?

In recent years, the Centers for Medicare and Medicaid Services (CMS), the Department of Defense (DOD), the Department of Justice (DOJ) and other federal agencies have intensified their efforts to combat healthcare fraud. Healthcare is a multi-trillion-dollar industry, with a significant portion of that money coming from Medicare, Medicaid, Tricare and other federal government programs.

The federal government’s efforts to combat healthcare fraud range from establishing an elite task force comprised of top agents and prosecutors (the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT”) to using big data to identify anomalies that may be indicative of fraud. Unfortunately, while this reliance on data has saved the federal government billions, it has forced numerous innocent healthcare providers to defend themselves in unwarranted investigations as well.

What Constitutes Healthcare Fraud?

“Healthcare fraud” is a broad term that encompasses a wide range of offenses under a number of different federal laws. Three of the most common forms of healthcare fraud include:

• Anti-Kickback Violations – The Stark Law and other federal laws prohibit physicians and other healthcare providers from receiving referral fees, rebates and other “kickbacks” under a variety of circumstances.

• Billing Fraud – This involves submitting false or fraudulent reimbursement requests to Medicare, Medicaid, Tricare and other benefit programs. Some common examples include things like billing for services that were never provided (phantom billing) and double-billing.

• False Claims Act Violations – Both the federal government and private citizens can initiate litigation under the False Claims Act. Billing fraud and anti-kickback violations are both common examples of False Claims Act violations, as are unbundling services in order to claim higher reimbursement rates and submitting fraudulent physician certifications.

Healthcare fraud can be charged as both a civil and a criminal offense. A finding of civil liability can mean thousands, if not hundreds of thousands or millions of dollars in fines and penalties, while a criminal conviction for healthcare fraud can potentially mean decades of federal incarceration.

When Should You Hire a Healthcare Fraud Defense Attorney?

If you or your business is facing a federal investigation for healthcare fraud in the Raleigh area, it is critical that you speak with a federal criminal defense attorney as soon as possible. You are entitled to legal representation during the government’s investigation, and hiring a lawyer before you get charged can have numerous benefits.

At the top of the list, if the government will not drop the investigation, your attorney will be able to argue that your case should remain civil in nature. Keeping your case civil reduces your potential exposure, and it keeps prison time off of the table.

Learn more about the benefits of hiring a lawyer during your federal healthcare fraud investigation.

Schedule a Confidential Initial Consultation at Cheshire Parker Schneider & Bryan, PLLC

The Raleigh, NC criminal defense attorneys at Cheshire Parker Schneider & Bryan, PLLC have decades of experience representing clients in healthcare and other federal investigations. If you have been contacted by federal agents, received a subpoena or suspect that you may be the target of a federal investigation, call (919) 833-3114 or contact us online to schedule a consultation today.