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DC Federal Healthcare Fraud Lawyer

Billions of American dollars are lost each year through various forms of health care fraud, including Medicare and Medicaid fraud. Because of the financial toll on the insured, taxpayers, and the U.S. economy, the penalties for such offenses carry heavy fines and imprisonment upon conviction. A DC federal healthcare fraud lawyer can explain how federal charges of this nature may play out in federal court.

When a whistleblower reports alleged healthcare fraud, or when suspicious claims require investigation, government agencies such as the Federal Bureau of Investigation (FBI), the US Secret Service, the Office of the Inspector General (OIG), and even the US Postal Service (USPS), among other law enforcement agencies are tasked with investigating and uncovering fraud involving both federal and private healthcare insurance. Healthcare fraud falls under the umbrella of federal white collar crimes. Healthcare fraud cases are prosecuted in the US District Court, which in DC is located in the E. Barrett Prettyman Courthouse at 333 Constitution Avenue NW. Only a federal criminal defense attorney who is licensed to practice in federal court can represent clients in cases involving these serious charges.

Defining Healthcare Fraud

Healthcare fraud can take on many forms by which the benefits available for legitimate medical services are misappropriated because of fraudulent or falsified information. Fraud may involve an individual or medical group, and it may involve only a single incident or may be part of an elaborate scheme. When a DC federal healthcare fraud lawyer investigates the details of a case, they will explain how any of the following healthcare fraud “schemes” may apply to the specific circumstances.

Cases of healthcare fraud which involve medical practitioners may often include one or more of the following:

  • Billing for services not rendered
  • Filing duplicate claims
  • False coding of medical procedures
  • Falsifying date/description of services
  • Falsifying medical records
  • Prescribing unnecessary treatments or procedures
  • Acquiring unnecessary subsidized or covered prescription pharmaceuticals with the intent to sell for profit
  • Accepting/providing kickbacks for member/patient referrals
  • Fraud involving Medicare or Medicaid

Healthcare and insurance policy carriers or members can commit fraud by participating in the following actions:
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  • Forging prescriptions
  • Selling prescription drugs
  • Using another’s insurance card and information
  • Using medical benefits for non-medical uses
  • Falsifying personal information when applying for benefits

If suspicious activity is detected, an investigation or inquiry may begin immediately. If an individual is the subject of a healthcare fraud investigation, including Medicare or Medicaid fraud, it is important to seek legal counsel immediately. A DC federal healthcare fraud defense attorney can advise a client on their rights and try to help the client avoid incriminating missteps throughout the investigative and interrogative processes.

Medical Identity Theft

National Healthcare Anti-Fraud AssociationA report provided by the National Healthcare Anti-Fraud Association (NHCAA) estimates that up to half a million people have fallen victim to medical identity theft. By failing to secure personal medical information, a person may find themselves with the details of another person’s medical history littering their own medical record.

By using another person’s medical and insurance information, a theft offender may be able to obtain treatment for a disease or condition while keeping their own medical record clean. A lost insurance card, explanation of benefits (EOB) thrown into the trash, or medical bill swiped from the mailbox are just a few of the ways an unsuspecting individual can become the victim of medical identity theft.

Healthcare Fraud Penalties

The US Code addresses the penalization for the successful execution or deliberate attempt to defraud any healthcare benefit program or illicitly gain any money or property available through any healthcare benefit program. Under 18 US Code Section 1347, a health care fraud offense typically carries a fine in addition to a maximum of 10 years in prison.

In some cases, health care fraud affects more than the paperwork in a person’s file. Falsified information, in some cases, can lead to unnecessary or life-threatening treatments or procedures. If a case of fraud results in a serious bodily injury in which the patient is at a substantial risk of death, incurs extreme physical pain, suffers visible disfigurement, or sustains the loss or impaired function of an organ, mental capacity, or body member, the term of imprisonment is increased to a maximum of 20 years.

If a particular health care fraud offense results in the death of another person, the maximum penalty if convicted increases to life sentence in prison. With such severe penalties at stake, it is important to consult with a DC federal healthcare fraud lawyer before making any important decisions with a case.

What Lawyers First Look At

When presented with a healthcare fraud case for the first time, lawyers begin by looking for any documents produced by the government, such as an affidavit, in support of a search warrant or an affidavit in support of an arrest warrant. Any documents the lawyer can obtain that were produced by the government or by law enforcement are important to review. The lawyer then has a discussion with their client, about the documents, to gather more information. Finally, the lawyer begins their own investigation.

What to Look For When Choosing Representation

When looking for an attorney, clients should look for lawyers who work hard, because the success in a healthcare fraud case is directly related to the amount of time spent on the case. That includes gathering information, looking at the legal issues, and doing a thorough investigation. When there is a trial, the lawyer does preparation work for the trial. Hard work and knowledge of the subject matter are two of the most important things to look at because healthcare fraud cases can involve highly technical issues. It is important to have a lawyer with experience dealing with these issues and has handled healthcare fraud cases before, including those involving Medicare and Medicaid.

Contacting a Washington DC Healthcare Fraud Attorney

According to the FBI, it is estimated that up to 10 percent of all healthcare expenditures are the result of fraudulent billing to both private and public healthcare programs, like Medicare and Medicaid. Because of the lucrative payout, healthcare fraud is becoming a more prevalent form of organized crime, calling the FBI and other federal agencies to take action.

Those cracking down on healthcare fraud push to see it penalized to the maximum extent of the law. A federal healthcare fraud defense attorney is capable of challenging US prosecutors that are tasked with the burden of proof, in order to help their client achieve the best possible outcome in each personalized case.

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