What are Your Potential Defenses to HealthCare Fraud Charges
When federal prosecutors bring healthcare fraud charges against you, you must defend yourself. Having aggressive healthcare fraud defense lawyers on your team is critical. Each case is very fact-specific. However, below are some of your potential defenses to healthcare fraud charges.
The five most important Federal fraud and abuse laws that apply to the health care industry and physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).
Federal law enforcement agencies, including the Department of Justice (DOJ), the Department of Health & Human Services (DHHS), Office of Inspector General (OIG), and the Centers for Medicare & Medicaid Services (CMS), are responsible for overseeing these programs and laws.
HealthCare Fraud and False Claims Act [31 USC 3729-3733]
The civil FCA protects the Government from being overcharged or sold unacceptable goods or services. Submitting claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent is illegal.
Filing false claims may result in fines of up to three times the program’s loss plus caps per claim filed. Under the civil FCA, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly. The fact that a claim results from a kickback or is made in violation of the Stark law also may render it false or fraudulent, creating liability under the civil FCA as well as the AKS or Stark law.
Lack of Intent, Knowledge or Mistake
To commit fraud, you must have the intent to cheat the government, victim, or insurer out of money. If you can prove that you acted in good faith but made an honest mistake, accidentally omitted information, made an error, or billed improperly, you should not be convicted of health care fraud. Federal prosecutors must demonstrate that you knowingly engaged in fraudulent activities with the intent to deceive government programs or insurers such as Medicare or Medicaid. One potential legal defense to a healthcare fraud case is arguing a lack of intent or knowledge.
Insufficient Evidence of HealthCare Fraud
Having an internal healthcare fraud compliance program can deconstruct the government’s evidence of healthcare fraud. The prosecution must have evidence of your intent to defraud and enough evidence to prove its case beyond a reasonable doubt. You cannot be convicted without this level and proof of sufficient evidence. This is where our healthcare fraud defense lawyers can help.
You Have a HealthCare Compliance Program
An experienced healthcare fraud lawyer can help you develop a thorough compliance plan to detect or deter fraudulent activity in your practice or business. Evidence of a comprehensive compliance plan can be potentially used to show you lacked intent to engage in health care fraud. Arguably, one of the most powerful legal defenses against healthcare fraud by a healthcare fraud attorney is evidence of a robust compliance plan that was initiated before the alleged healthcare fraud.
Medical providers or potential defendants in a civil or criminal fraud case can be charged with healthcare fraud even if you did not know you (or your business) were committing healthcare fraud and even if you are relying on the advice of an attorney. Evidence of a healthcare compliance plan can be used to show that the corporation or practitioners lacked the requisite intent to engage in healthcare fraud.
Present Evidence of Legitimate Services
Another of the potential defenses to healthcare fraud charges is to present credible evidence that your medical services were legitimate and necessary. You can possible introduce evidence through patient medical records, expert testimony supporting your treatment decisions, and documentation showcasing compliance with applicable laws and regulations. Demonstrating a consistent pattern of providing high-quality care will help counter the government’s allegations of fraudulent billing practices, and it can also show that your practice is committed to protecting the well-being of patients rather than financial gain. Watson’s healthcare fraud defense lawyers can help you in this regard.
Consent
You do not commit fraud if you were granted permission for your actions by the alleged victim. Evidence you were given permission to do what you are accused of is a defense against the charges.
Anti-Kickback Statute Safe Harbors
There are several “safe harbor” provisions including certain investments, space or equipment rental, personal services, management contracts, sale of practice, referral disclosures, warranties, discounts, group purchasing arrangements, waivers, some types of price reductions, practitioner recruitment, some malpractice subsidies, and referrals for specialty services. There may be others based on specific services like ambulatory surgery centers or health centers.
Exceptions in the Stark Law may permit physicians to make referrals in limited circumstances. These can include in-office ancillary services, fair market compensation arrangements, non-monetary compensation, and risk-sharing arrangements. Physicians must be mindful that even though a Stark Law exception applies, if a referral is made in exchange for payment, it could still violate the Anti-Kickback Statute.
Voluntary Disclosure – The agencies that oversee federal fraud and abuse laws have incentives to self-report violations, including a reduction in payments owed. However, there are risks with self-reporting and an experienced lawyer can help you determine if that is an appropriate avenue for you.
The federal government had implemented immediate COVID-19 waivers, which loosened some health care fraud regulations. If you being investigated under investigation, call one of our national healthcare fraud lawyers for immediate help.
Help Immediate Help from Aggressive HealthCare Fraud Defense Lawyers
If you are at the investigating stage or trial stage in a health care fraud case, our legal defense lawyers can help with your potential defenses to healthcare fraud charges. Call Today at 1.866.601.5518. Speak to Lead Attorney Theodore Watson.