Health Care Fraud

Most health care payment systems operate on a kind of automatic pilot. A person obtains coverage under a private or public insurance plan, consults a health care provider who orders various tests and/or treatments, and a bill for these procedures is submitted to the insurer. In the vast majority of cases, the insurer simply relies on the information submitted. No one has the time to make a personal examination of all the details of the bill. This makes it remarkably easy for people to collect money through fraudulent claims: procedures billed but not actually performed, procedures performed for no medical reason, procedures performed in a way that increases the overall cost, and so on. One estimate is that fraud—taking into account both money fraudulently paid and the activities employed to prevent fraud—accounts for about 10 percent of all Medicare and Medicaid costs. If you have been accused, call a Tampa health care fraud lawyer to discuss your legal options

Combating Health Care Fraud Can Catch the Innocent

When it comes to Medicare and Medicaid fraud, the government really has an incentive to recover any funds lost due to fraud. These recoveries go a long way toward both funding the efforts to combat fraud and adding funds back to the programs. Reportedly, the federal government’s primary fraud control program, a joint effort of the Department of Justice and the Department of Health and Human Services (HHS), recovered $8 for every dollar it spent in the period from 2011-2013.

At the state level, Florida’s Medicaid Fraud Control Unit, charged with preventing and prosecuting Medicaid fraud, reportedly recovered over $460 million in the period of 2011 through mid-2014.

The intense focus on preventing fraud, however, can lead investigators to go overboard. Not every billing error is fraud, not every order of a retest is fraud, and not every decision that might increase the cost of care is fraud. And not every health care practitioner who has a connection to someone committing fraud is in on the fraud. For a licensed health care worker, even being investigated for fraud can make it harder to obtain and keep a job. A conviction carries the loss of license and reputation, as well as possible fines and prison time.

The stakes are incredibly high for any medical person being investigated for fraud. The best protection is to get the aid of an experienced defense attorney who understands fraud prosecutions generally, and the very specific nuances of health care fraud claims.

Intent is Central to Fraud

The intent of the person accused of health care fraud is usually the central issue in the case. While intent can be clear in some circumstances, in many other cases intent must be inferred from the actions of the person accused. Prosecutors tend to develop a theory and cling to it. Once they have decided there was intent, all other evidence is interpreted through that lens. An experienced fraud defense lawyer’s job is to show the prosecutors, the court, and any jury that the facts are just as consistent with a lack of fraudulent intent.

Obtaining the assistance of an experienced Tampa health care fraud lawyer just as soon as you have any reason to think that an investigation may be going on serves several purposes:

  • The defense lawyer has the maximum opportunity to investigate; waiting gives the prosecution a head start;
  • The defense lawyer has an opportunity to educate you on what is going on behind the scenes, which can both improve your peace of mind and prevent you from unintentionally damaging your own defense with careless statements;
  • The defense lawyer may be able to point out alternative, innocent explanations for your behavior before the prosecutors latch on to a theory that shows guilt.
Get Quality Legal Help in and Around Tampa Bay

Tampa criminal attorney William Hanlon knows what is at stake in a health care fraud case: your professional future. With 20 years experience defending against Florida fraud charges and the highest possible AVVO rating, he understands the subtleties of these cases and how prosecutors and investigators operate in building their cases. Call Will Hanlon today for the peace of mind that comes with knowing that you have a skilled advocate devoted to your best interests and the best possible outcome for your future.