Hospital Fraud

Given that hospitals are complex organizations, especially when they operate as part of a larger medical system, employees make mistakes even when best practices are followed. Certain accounting or billing mistakes can leave a hospital open to charges of fraud which may be prosecuted at the federal level. The potential ramifications of hospital fraud are severe and could result in criminal penalties even for an unintentional error.

Those with concerns about allegations of hospital fraud involving coding errors, the False Claims Act, falsified records, kickbacks, or other potential issues are advised to consult a Michigan hospital fraud lawyer. Whether charges have been filed, an investigation is underway, or you are seeking to put compliance measures into place to avoid problems in the future, an experienced healthcare fraud attorney can help find solutions to fit your needs.

Healthcare fraud is a term that covers a broad range of activities. Since fraud occurs when someone uses deception to gain a benefit improperly, healthcare fraud typically involves the use of deceptive practices to profit illegally from insurers or government healthcare programs.

Both providers of healthcare and recipients of healthcare may commit healthcare fraud. Moreover, different practices involving healthcare fraud are prohibited by laws at both the state and federal level.

In many cases, the federal government will prosecute healthcare fraud when a scheme involves a hospital or any other large provider. No matter the specific situation you face, a hospital fraud lawyer in Michigan can help you formulate an effective and comprehensive defense.

While individuals may commit healthcare fraud by providing false information to obtain healthcare, forging prescriptions, or other practices, most healthcare fraud is prosecuted against hospitals and other providers. As a knowledgeable attorney could explain, examples of situations that could be treated as hospital fraud in Michigan include:

• Taking kickbacks for referrals
• Unbundling or billing separately for tests and procedures that should be billed as a package at a lower rate
• Billing for services that are not provided or are unnecessary
• Falsifying records or test results
• Upcoding or billing for a more expensive procedure than the patient received
• Reselling subsidized medications obtained under false pretenses

No matter the specific behavior, hospital fraud may be penalized very severely even if a coding error or other mistake caused it. Consequently, it is typically wise to take all available steps to address concerns regarding past incidents and put measures into place to ensure compliance going forward—all of which a hospital fraud attorney in Michigan could help with.

The federal government may prosecute forms of healthcare fraud involving hospitals under several different laws. As an example, 42 U.S.C. 1320a-7b provides criminal penalties for false statements made to obtain benefits from federal healthcare programs. Federal criminal provisions contain general prohibitions against healthcare fraud, and the federal False Claims Act provides for civil actions against hospitals and other healthcare providers who take actions perceived to involve fraudulent claims.

Penalties for violating criminal provisions include the potential for up to ten years of imprisonment and extremely high fines. While civil violations may not subject anyone to a jail sentence, they still involve serious financial consequences and could make it difficult to obtain payments from federal sources in the future. A well-practiced Michigan attorney could explain which penalties for healthcare fraud a person may face, and could build their defense case.

The federal government vigorously prosecutes hospital fraud because so many hospitals receive funds through Medicare and other federal healthcare programs. Since federal authorities have vast resources at their disposal and teams of experienced legal professionals working on cases, it could be challenging to defend against charges of hospital fraud.

Preparation is often the key to success when creating a defensive strategy, so it may be wise to consult a knowledgeable Michigan hospital fraud lawyer immediately concerns arise. A dedicated attorney could help collect evidence and provide professional experienced representation to help pursue a positive outcome. Call today to schedule a consultation and learn more.