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Maryland Federal Healthcare Fraud Lawyer

Each year, Americans spend trillions of dollars in healthcare costs. With so many medical services billed, and so much money exchanging hands, it is no surprise that there are many people who take advantage of the big business of healthcare by using fraud to turn a little extra profit.

If someone discovers that they are under investigation and are suspected of committing healthcare fraud, it is important that they contact a Maryland federal healthcare fraud lawyer at once. If they are under investigation for healthcare fraud, law enforcement has probably started looking into their business practices long before the person being investigated is aware of the government’s probe. Finding a defense attorney equipped to be representation before the United States District Court for the District of Maryland is critical to mounting a strong and aggressive defense based on the facts of the case.

Defining Healthcare Fraud

Healthcare fraud is any attempt to defraud a healthcare benefits program. Whether lying, misrepresenting or concealing information to receive Medicare benefits or submitting false invoices for reimbursement for medical services not provided to a patient, healthcare fraud is an attempt to manipulate the truth in order to gain money or services to which one is not lawfully entitled.

In some cases, healthcare fraud may be committed by a patient. A person may submit fraudulent information on a Medicare application, or they may provide their Medicare number to someone else to allow that person to receive medical benefits. Frequently, however, healthcare fraud is not committed by a patient, but by a healthcare provider.

Common healthcare fraud schemes include the following:

Other healthcare fraud schemes may include:

  • Billing for more excessive services, procedures, or equipment than is actually provided
  • Accepting kickbacks for patient referrals or for using a particular medical device or medication
  • Unbundling procedures, or billing separately for each step of a procedure rather than for the procedure as a whole

Because of the prevalence of fraud in the healthcare industry, the federal government’s Medicare and Medicaid programs are dubbed “high-risk” programs. With the sheer number of claims processed annually in the United States, the federal government often relies on whistleblowers to report fraudulent activity related to healthcare benefits.

Whether someone is a patient or a healthcare provider being accused of fraud, a Maryland federal healthcare fraud lawyer can work with them to determine a suitable defense plan. Their lawyer will be able to investigate the details pertaining to their charges and determine how to mitigate the damage to them or their company.

Prevalence of Fraud

The true cost of healthcare fraud is unknown, but estimates show it to be extraordinary. Both the FBI and the National Health Care Anti-Fraud Association (NHCAA) say that healthcare fraud costs the country “tens of billions” of dollars each year, and a 2010 CNN Money report said healthcare fraud cost the government and taxpayers $100 billion annually.

Those who commit healthcare fraud typically have no intention of hurting anyone. Sometimes, they are motivated to commit fraud out of financial desperation. Other times, they may feel as if the hours they put into their profession are not adequately reimbursed, and that the healthcare industry owes them more than it is giving. It is easy for people to believe that health care fraud is a victimless crime, but the federal government certainly does not see it that way.

The FBI and other federal agencies, including the Department of Health and Human Services Office of the Inspector General (HHS-OIG), the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the National Health Care Anti-Fraud Association, and the National Insurance Crime Bureau (NICB) relentlessly pursue allegations of healthcare fraud, and U.S. Attorneys’ Offices vigorously prosecute these cases in federal court. With so many government resources being earmarked to prosecute fraud, it is prudent for someone to retain a Maryland federal healthcare fraud lawyer to defend their best interests in matters relating to their case.

Federal Laws

The general statute pertaining to federal healthcare fraud is codified in 18 U.S. Code § 1347. Under this law, anyone who attempts to defraud a healthcare benefits program in any way commits a federal felony punishable by a maximum of 10 years in prison, as well as fines and restitution. However, if the fraud scheme results in serious bodily injury or death, the maximum penalty is enhanced: 20 years or life in prison, respectively.

In addition to the federal healthcare fraud statute, there are a number of other federal criminal laws which may apply to a particular healthcare fraud case:

  • False Claims Act: 31 U.S. Code Sections 3729–3733
  • Physician Self-Referral Law: 42 U.S. Code Section 1395nn
  • Anti-Kickback Statute: 42 U.S. Code Sections 1320a–7b(b)

Contacting a Lawyer

Anyone suspected of healthcare fraud may also face separate liability for civil damages and may be subject to civil lawsuits that run parallel to any criminal investigation. The federal government does not take healthcare fraud lightly. If someone is suspected of Medicare fraud, Medicaid fraud, or another act of healthcare fraud, they can expect the federal government to be unrelenting in its prosecution. The person facing charges should be prepared to fight back with the counsel and representation of a Maryland federal healthcare fraud lawyer armed with a strong defense based on the facts of your particular case.