Healthcare Fraud Defense

Healthcare fraud is costly for taxpayers who end up paying for kickbacks, referrals, and other illegal practices, and for healthcare providers accused of fraud. However, practices that may appear on the surface to violate healthcare fraud laws often fit within statutory exceptions or might be unintentional mistakes. Either of these may reduce a defendant's exposure to liability.

If you are under investigation for or facing allegations of fraudulent practices in a medical context, an experienced Michigan healthcare fraud defense lawyer can explain the applicable laws and sanctions for violations, help uncover valuable evidence, and advocate on your behalf to reach a positive outcome. Reach out to a well-versed fraud attorney for legal advice and guidance.

Why the Federal Government Gets Involved in Michigan Healthcare Cases

While it may be not surprising that the federal government investigates and prosecutes activities involving multi-state conduct, the federal government also prosecutes cases that may involve a single office in Michigan. The reason for this is that many healthcare providers receive payments from the federal government through programs such as Medicare and Medicaid. While medical fraud is prohibited by Michigan laws and federal laws, the federal government may take the lead on a case involving alleged, fraud since federal funds are so often involved.

Practices Prohibited as Healthcare Fraud

Situations that allegedly constitute healthcare fraud may be based on an innocent billing error. In other cases, a physician's assessment of the need for particular services might be called into question as potentially fraudulent. Overall, there are numerous practices that could be prosecuted as medical fraud. As a knowledgeable attorney could explain, these include and are not limited to:

• Physician self-referrals/Stark Law violations
• Unbundling or billing separately for services that should have been bundled
• Upcoding or billing for services more extensive and expensive than those provided
• Falsifying records or test results
• Offering or accepting kickbacks for referrals
• Billing for services or medications never provided
• Provision of unnecessary services
• False billing for a non-covered service

In certain cases, providers engage in these practices in a deliberate attempt to obtain federal funds fraudulently. In other situations, these practices occur due to mistake or a difference in judgment. A skilled medical fraud defense attorney in Michigan may know how to build the most effective defense based on the unique circumstances of a particular case.

Applicable Laws and Penalties

The federal government may prosecute suspected healthcare fraud using an array of different civil and criminal statutes. Also, private individuals often file lawsuits alleging health care fraud under statutory provisions encouraging the public to "blow the whistle" on practices that may defraud the government.

As an example, the False Claims Act contains qui tam provisions allowing this type of lawsuit. If such actions succeed in recovering damages, the person who files the claim is entitled to a share of the recovery. This could, in turn, encourage others to file qui tam lawsuits. In conjunction with the False Claims Act, cases may be prosecuted under the Stark Law, the Anti-Kickback Statute, the criminal provisions of 18 U.S.C. §1347, and other federal and state laws.

Penalties for criminal violations may include up to 5-10 years in prison, and fines that could be assessed for criminal or civil violations could amount to hundreds of thousands of dollars. Those found to have committed health care fraud may also be prohibited from ever again participating in Medicare and other federal health care programs. Given the potential penalties of healthcare fraud, accused individuals should speak with a skilled Michigan attorney to learn their options for a defense case.

Contact a Michigan Health Care Fraud Defense Attorney

Some healthcare fraud laws require an action to be taken with knowledge of the fraudulent circumstances for a violation to occur. Other laws contain no such requirement, so it is possible to commit a violation without realizing any wrongdoing has transpired.

Given the high stakes, it is wise for anyone concerned with allegations of health care fraud to consult an accomplished Michigan healthcare fraud defense lawyer as soon as possible. To set up a consultation and learn how a hard-working medical fraud defense attorney can assist in your situation, call now.

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