Have you been accused of healthcare fraud in Lexington, KY? Whether it is committed by a consumer or a medical provider, healthcare fraud is taken seriously under Kentucky and federal law. You are facing not only jail time but hefty fees, penalties, interest, and even the loss of government contracts and your license.
Since 2009, Suhre & Associates, LLC has defended clients against all types of serious fraud allegations. Contact our law office at (859) 569-4014 and schedule your free case review with a Lexington healthcare fraud lawyer ready to fight for you.
How Suhre & Associates, LLC Can Help if You’re Charged with Healthcare Fraud
Healthcare fraud is a common white collar crime in Lexington. However, do not assume that the penalties for conviction are not serious. The consequences of healthcare fraud conviction are broad, and you may face investigation from local, state, and federal authorities.
When you are facing allegations of healthcare fraud, it’s crucial to act quickly to protect your rights and defend yourself. You deserve an aggressive defense from a Lexington criminal defense lawyer experienced with state and federal fraud charges.
When you trust Suhre & Associates, LLC with your legal defense, we will:
- Provide sound legal advice to help you understand the possible outcomes of your case, defense strategies, and what we believe are your chances of beating the charge
- Work with top experts in multiple fields for expert testimony that levels the playing field against the experts federal and state prosecutors will use against you
- Analyze and exploit weaknesses in the case against you to argue the prosecution has not met the burden of proof
- Protect your constitutional rights
- Negotiate for a dismissal or reduction of the charges or the most lenient sentencing possible
- Present a persuasive case in court to seek an acquittal
Healthcare fraud is taken seriously and typically investigated by task forces and coalitions of state and federal law enforcement agencies. You deserve a legal advocate in your corner who will fight to protect you.
Our attorneys, including a former police officer and former prosecutor, have over 100 years of combined experience in criminal defense work. Call our Lexington, Kentucky criminal defense law office today to schedule a free consultation. A Lexington healthcare fraud defense lawyer is waiting to help you.
What Is Healthcare Fraud in Kentucky?
According to the Department of Justice (DOJ), healthcare fraud occurs when a company, person, or group misrepresents something about the nature, scope, or type of medical care provided in a way that may cause unauthorized payments. This type of fraud may be committed in many ways by both providers and consumers.
The DOJ and Health and Human Resources (HHS) coordinate a multi-agency team within the Medicare Fraud Strike Force with local, state, and federal investigators. These agencies also coordinate with the Health Care Fraud Prevention and Enforcement Action Team (HEAT), Office of Inspector General (OIG), and Centers for Medicare & Medicaid Services (CMS).
Despite the government’s focus on Medicare or Medicaid fraud, all types of health insurance companies and insurers are protected. This includes workers’ compensation and insurers like Anthem Blue Cross Blue Shield and UnitedHealthcare.
Healthcare fraud may be committed in many ways.
Examples of healthcare fraud committed by providers include:
- Double billing
- Billing non-covered services as covered services
- Billing for services that were not provided
- Providing and billing for services that were not needed
- Unnecessary prescriptions
- Accepting kickbacks and bribes
Consumers or healthcare users may commit healthcare fraud by:
- Falsifying information. This may be done on a Medicaid or Medicare application to receive benefits, for example.
- Prescription forgery or selling prescription drugs
- Adding ineligible dependents to a medical plan
- Using someone else’s health insurance card
- Identity theft for healthcare purposes
Depending on the type of healthcare fraud that is committed, fraud may be charged as a state or federal offense. You may face charges under several statutes.
Federal Healthcare Fraud Charges
Healthcare fraud is covered by 18 U.S. Code § 1347. This is the main statute for healthcare fraud.
A person or company violates this law when they knowingly execute or attempt to execute any scheme to:
- Defraud any health care benefit program or
- Obtain any property or money owned by or under the control of a health care benefit program through false or fraudulent pretenses or representations
This federal offense comes with very harsh penalties.
Kentucky Control of Fraud and Abuse Act
Kentucky law also makes it a crime to commit Medicaid fraud under Kentucky Revised Statutes Chapter 205. This statute applies to false or fraudulent statements, entries, or representations in claims, applications, reports, and documents to determine payment under Medicaid.
Medicaid fraud under Kentucky law is a misdemeanor or felony depending on the amount illegally collected and the type of fraud.
What Are the Penalties for Healthcare Fraud in Lexington, Kentucky?
The penalties for healthcare fraud in Lexington are serious. You may face penalties for state and/or federal charges depending on the nature of the offense and whether it involved a government program.
Healthcare fraud penalties can extend far beyond jail time. You may face significant penalties under the False Claims Act. Health care professionals may face collateral consequences as well, such as a loss of their professional license.
Penalties for Federal Healthcare Fraud
Conviction of federal healthcare fraud can be punishable by up to 10 years in prison. When the offense results in serious bodily injury, it may be punishable by up to 20 years. This penalty is increased to any term or life imprisonment if it results in death.
Penalties for Kentucky Medicaid Fraud
A false claim under Kentucky law can result in penalties of up to $500 per claim, 3x the amount of falsely collected payments plus interest, and payment for the government’s legal costs. It can also be punished by exclusion from the Medicaid system for up to 5 years.
It is also punishable as a misdemeanor or felony. The charge and penalty will depend on the type of fraud and amount collected fraudulently.
Additional Penalties for Healthcare Providers
Healthcare providers convicted of healthcare fraud can face a range of penalties outside of jail time, fines, and penalties. A provider who engages in healthcare or insurance fraud can lose their license to practice. This consequence can result from any type of healthcare fraud.
Providers may also be barred from participating in government benefit programs like Medicaid and Medicare if convicted of healthcare fraud.
A conviction and certain other negative actions involving fraud must also be reported to the National Practitioner Data Bank (NPDB). This may affect participation in other insurance plans.
Providers can even be subject to criminal forfeiture and asset seizure by the federal government.
Federal False Claims Act
The Federal False Claims Act (31 U.S.C. §§ 3729-3733) makes people, institutions, and companies liable for making or causing fraudulent or false claims to the government. This statute applies when someone knowingly uses, makes, or causes to be made any false records or statements for a fraudulent or false claim to be paid by the government.
The Federal False Claims Act applies to reimbursement for both Medicare and Medicaid.
The False Claims Act is unique because it allows private citizens to file lawsuits against people or businesses who directly or indirectly defraud the government. The federal government also has the right to file a False Claims Act lawsuit. Someone who has been found in violation of the False Claims Act can be ordered to pay the federal government 3x the amount of damages plus civil penalties of up to $21,916 for every fraudulent or false claim.
Violators can also be disqualified from participating in future contracts with the government.
What Defenses Can Be Raised if I’m Accused of Healthcare Fraud in Lexington, KY?
There are many possible legal defenses to allegations of healthcare fraud. At Suhre & Associates, LLC, our Lexington healthcare fraud attorneys will conduct a careful review of your case to determine the best defense strategy.
Many cases of healthcare fraud come down to whether the accused acted with “fraudulent intent.” Your case may be won by showing you made a mistake without fraudulent intent or otherwise acted in good faith.
A good faith defense can be used in many scenarios. If you are accused of overbilling, you may claim the billing was appropriate. It may also be the result of simple clerical errors.
You may also build a defense around a claim that the fraud was committed by someone else. It can be very difficult to prove who precisely was responsible for fraudulent billing in medical offices with tasks shared among multiple people.
There may be additional defenses such as:
- Insufficient evidence to prove you committed fraud beyond a reasonable doubt.
- A compliance program that shows you had no intent to engage in fraud.
- “Safe harbor” provisions that may protect you from anti-kickback claims.
- COVID-19 waivers implemented by the federal government apply to some regulations.
Schedule a free initial consultation with Suhre & Associates, LLC, so we can help you explore possible legal defenses in your case.
Contact a Lexington Healthcare Fraud Lawyer for a Free Consultation
If you are under investigation for or charged with healthcare fraud, it’s important to act quickly to protect your rights and begin building a strong defense. At Suhre & Associates, LLC, we will work tirelessly to defend you and fight for your freedom and good name.
Call our law firm to schedule a free consultation with a Lexington healthcare fraud lawyer. We will give you an honest assessment of your case and help you decide on the next steps to take.