Federal justice system officials aggressively investigate and prosecute individuals in the health care industry who knowingly submit false statements or misrepresent facts to obtain payment from Medicare or Medicaid. If convicted of this type of fraud, you can face very serious consequences, including thousands of dollars in fines, loss of your professional license and career, and significant prison time.
If you are being investigated for Medicare or Medicaid fraud, your future is at risk. Having an experienced Orlando healthcare fraud attorney intervene early on your behalf is in your best interest. If, however, you’ve already been charged with fraud, you definitely need an experienced Medicare/Medicaid fraud defense attorney.
Jonathan Rose has been practicing law for twenty years. As a former prosecutor, he knows the tactics investigators and prosecutors use in preparing cases and will develop an aggressive defense strategy that will best protect your interests.
Medicare Fraud Laws
There are several federal statutes dealing with Medicare fraud:
- The False Claims Act is the most basic, prohibiting an individual from issuing a fraudulent claim for payment by the government, conspiring to submit a fraudulent claim, or receiving funds from a fraudulent claim.
- The federal Anti-Kickback Statute prohibits business transactions between health care industry providers that are intended to induce or reward referrals for services or items paid for by Medicare or Medicaid.
- The Stark Law encodes a system for preventing physicians from referring patients to health care industry organizations that they have a financial interest in.
Medicare fraud convictions require proof beyond a reasonable doubt that you knowingly and/or willfully submitted a fraudulent claim, engaged in kickbacks, violated the provisions of the Stark Law, or committed another act of health care fraud. However, you can be convicted on the basis of having acted with deliberate ignorance of or reckless disregard for the truth or falseness of a claim.
Examples of Medicare Fraud include, but are not limited to:
- Submitting false claims to CMS
- Billing for services or supplies that weren’t provided
- Billing for tests or treatments separately when the procedure code bundles them together
- Billing for a higher code than the service provided
- Performing tests or treatments that were not medically necessary
As these examples suggest, the charges depend on your having acted knowingly and/or willfully in some cases, but in others, the standard of care and medical necessity are at issue. To defend against these charges, you need an experienced health care fraud attorney who understands the standard of care, clinical practice guidelines, and conditions of payment.
Defending Against Medicare and Medicaid Fraud Charges
In recent years, the federal government has been conducting more intensive, aggressive investigations of health care fraud. The U.S. Attorney’s Health Care Fraud Division can use previous employees, patients, and other confidential informants to help their investigation and prosecution, so you need a defense attorney who understands CMS regulations and health care fraud laws to fight for your rights and protect your interests.
As your attorney, Jonathan Rose will develop the best defense strategy possible. For example, the government’s witnesses might not be credible. The investigation might not have uncovered all of the facts, and/or incidental errors or negligence could have been mistaken for fraud.
The best defense, however, is an early defense. If you are being questioned or investigated about potential fraud, be sure to contact the Jonathan Rose law firm. The prosecutors may try to get information from you, but you should not talk with them before consulting with an attorney who specializes in health care fraud cases. At the Jonathan Rose law firm, we will put our knowledge of health care law and the federal justice system to work for you, analyzing investigation data and negotiating with prosecutors on your behalf.
Protecting Your Future
Medicare and Medicaid fraud are serious charges that can result in a felony conviction. Fines up to $250,000, prison terms up to 10 years, and loss of licensure are not uncommon sentences. Even if you are not prosecuted on criminal charges, you could still lose your professional license, and you could be excluded from CMS programs.
Getting legal help from an experienced Medicare fraud attorney is crucial to protecting your future. You need a federal defense attorney who focuses on fighting for the rights of physicians and other health care providers in criminal proceedings and with licensing boards and regulatory agencies.
If you are being investigated by the state or federal government for Medicare or Medicaid fraud, please contact the Jonathan Rose law firm as soon as possible. Attorney Rose has over 20 years of experience as a trial attorney and the expertise you need to develop a strong, comprehensive defense strategy to protect your rights, freedom, and future.