When presenting a healthcare fraud case for the first time, lawyers want to know and understand the specifics of the offense. Healthcare fraud can be claimed for many reasons, however, accusations mainly revolve around money and the way patients are charged.
Therefore, these charges should be taken seriously and confronted immediately with a Maryland federal healthcare fraud lawyer. Speaking with an established federal criminal attorney about how to handle such an accusation could be beneficial to the overall outcome of your trial.
One example of federal healthcare fraud is when a healthcare provider bills for nonexistent services. A healthcare provider may bill for services that were not provided. In this type of fraud, a healthcare provider fabricates and records services, treatments, or other types of care that were never provided. The provider bills for these charges and is paid, whether by the patient, an insurance company, or the Federal Government via Medicaid, Medicare, or another Federal program. A Maryland federal healthcare fraud lawyer could help potential clients better comprehend the way their specific case should be handled.
Another example of healthcare fraud is “upcoding”. There are specific codes associated with different treatments and the different types of healthcare. Sometimes a provider is accused of entering a code for more expensive treatment than what was actually provided and then pocketing that extra payment. Upcoding can also occur with medical equipment. An example would be providing a basic manual wheelchair, but coding and receiving payment for a more expensive electronic wheelchair. Also, there could be duplicate claims for the same procedure, even though it was only provided once.
Another type of fraud is “unbundling.” Many conditions are treated with multiple types of care. Care and services that are commonly provided together often are packaged or “bundled.” The bundled package of care costs less than if a patient were to be charged for each individual treatment separately. “Unbundling” is where the healthcare provider charges for each treatment individually, rather than charging for the bundled package, which constitutes criminal healthcare fraud.
Another example of healthcare fraud is when a provider bills for unnecessary or excessive procedures. Another example of fraud is when a specialist healthcare provider pays a commission to a general practitioner for a referral. Such a practice incentivizes doctors to refer patients not based on medical necessity, but based on the profit that would go to the referring doctor. This practice, often called a “kickback”, is another example of healthcare fraud.
Prescription fraud is issuing false prescriptions. It could be that they have the accused has a valid license to issue prescriptions, but uses that authority to write prescriptions when not medically necessary, whether for themselves, a family member, a friend, or stranger. Another type of prescription fraud is when a person writes a prescription without a medical license or the authority to do so.
These crimes are considered very serious. Many are aware of the epidemic of over prescription pain medications, especially opiate pain medications and the connections between the prescriptions of legally-prescribed painkillers.
It often serves as a gateway to abuse of heroin or other so-called street drugs, which is a problem these days. Prescription fraud is an issue that the prosecutors look at seriously. It is another area or subcategory of healthcare fraud that is prosecuted intensively.
Once a Maryland federal healthcare fraud lawyer understands those allegations, they want to see what facts are behind it. They talk to the client to see if they have any idea where these allegations are coming from, if it was something that they knew was going on and anticipated the charges, if it was something that seemed to come out of the blue, or if it was something that they were involved in with another employer or codefendant involved. They try to get a sense if the client may be forthcoming and helpful as they try to get an understanding of the situation.
The next step is looking at what the evidence actually shows. Once they have the understanding of what the government is alleging and the client’s perspective on the situation, what they have to say about what happened, and how true the claims are, they see what the government could prove. Did they already provide discovery, did they conduct an investigation, are they able to document of the allegations, is that what they are attempting to do, have they issued subpoenas, are they still gathering that evidence, if they do not have it are they looking for it, what do they need, what could prove these charges?