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DC Federal Health Care Fraud Offenses

When it comes to DC federal health care fraud offenses, there are a variety of ways in which the government can charge a person. If you are facing charges, speak with a white collar defense lawyer to discuss potential defenses and build strategies to anticipate and challenge the arguments of the prosecution.

Common Scenarios

There are many federal healthcare offenses a person can be charged with including the following three statutes used to charge such healthcare offenses.

The main offense is healthcare fraud which is committing fraud against a federal healthcare program such as Medicaid or Medicare. Other generic statutes used in the healthcare context include wire fraud and mail fraud. Wire fraud is a statute used to gain federal jurisdiction over a potential offense.

For example, an email is sent interstate between two states. It contacts the server in more than one state and is related to an offense that gives the federal government jurisdiction to charge wire fraud. The mail fraud statute addresses the use of U.S. mail as part of an offense that is also used to get jurisdiction

Fraudulent Billing

For example, there are situations and scenarios where the government goes after treating physicians who take patients who are eligible for Medicare or Medicaid and the doctors are accused of fraudulently billing the government. The government alleges that this particular doctor in any given week billed the government for 200 hours’ worth of work. That just seems impossible when there is one doctor working and the average person only works eight hours, perhaps 12 hours, in a day. In that case, the government will likely bring health charges against a subject. 

Often these cases are very document intensive and they require a person who has familiarity with how Medicare and Medicaid billing is done. Sometimes these issues come down to common mistakes in processing the bills. Often there can be an innocent and non-illegal explanation as to why the bills are not processed in the way that the government thinks they should be processed. That is a common charge.

Fraudulently Obtaining Benefits

There can also be a situation where a patient has allegedly defrauded the government by seeking benefits for which they are not eligible. For example, a person could falsely claim a disability and, as a result of that false documentation or false claim, collect disability benefit payments for years, amounting to hundreds of thousands of dollars. In that case, the government could bring charges against them for falsely claiming benefits. That is a kind of health care fraud.

Tax Fraud

There are also scenarios where the government will charge someone with tax fraud, alleging that the individual in question  received income fraudulently. Usually, a person did not pay taxes on it in order to conceal the full amount of the income. Often, the government charges an individual with the substantive offense and then adds a charge of tax fraud for not paying taxes on those ill-gotten gains.

Conspiracy Charges

When one has health care fraud charges, some charges that will go in tandem with them are conspiracy charges if there was more than one doctor or health care provider involved in the group.

Off-Label Marketing

Another area that has become really hot lately, and this affects both individuals and corporations, is off-label marketing. There are rules that the government — through the FDA and other agencies — has regarding how companies can market certain pharmaceuticals based on trials and studies that have been approved by the government and it is a crime in some cases to go outside of those lines. When that happens, it’s not uncommon for the government to bring charges of conspiracy and various charges for violating the narcotics pharmaceutical regulations.

Import and Export Violations

Interestingly, another area that has been on the rise that is related to health care is conspiracy to violate the import or export laws of the United States. There are scenarios where drugs are manufactured in the United States but then approved for distribution in a place like Canada and there are companies that will allegedly bring those drugs back to the United States for distribution because often times, in another country like Canada, they are significantly cheaper than they would be in the United States. The problem is that is a violation of federal law. The government has, on many occasions recently, brought cases against those companies who seek to violate the import-export laws and regulations for pharmaceutical drugs.

Law Enforcement Approach

There are many circumstances that can result in someone being charged with DC federal healthcare fraud offenses. Currently, federal prosecutors are focusing their investigations on companies that provide home healthcare services.

For example, home healthcare aids have been charged after being accused of falsifying the services they provide. Patients have also been charged or persuaded to be witnesses in federal healthcare fraud cases after being accused of participating by agreeing that the hours a home healthcare worker worked were valid. The patients were paid to confirm the hours worked for time the home healthcare worker was not even there. The companies and their owners that run these home healthcare services were charged.

There are a variety of other ways to commit healthcare fraud. Sometimes doctors become targets of federal government investigations. Doctors may be charged with improper billing for up-coding, which is taking the accurate service provided governed by particular codes and using a more expensive code that requires a higher payment by an insurance company to justify its service. There can also be charges of falsifying services. It is not a matter of increasing the price, but actually falsifying patients’ records or treatment records.

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