Healthcare providers are required to file claims that detail the services provided to patients to receive funding from various government and private sources. They are required to provide information regarding the payments requested, as well. Individuals who have been charged with healthcare fraud or suspect that they are under investigation should consult with an attorney with experience in healthcare fraud and who is well-versed in federal law. An experienced federal healthcare fraud lawyer has a thorough understanding of how to work with and in the court system. As you face the charges against you, having someone who knows the ropes on your side can help you to rest easy and give you some peace of mind, particularly if you’re heading to trial.

Prescription Fraud

When prescription drugs are acquired illegally for personal use or profit, it is a crime called prescription fraud. In some instances, prescription fraud involves accusations, such as the accusation that a pharmacist or a pharmacy owner issued prescriptions for drugs, such as opioid painkillers, for financial gain. In other circumstances, patients may write false prescriptions from a stolen prescription pad or obtain the prescription drugs by other means and sells the drugs or uses them personally.

Healthcare Fraud

Healthcare fraud cases are not merely limited to fraud against the government. They can involve fraudulent schemes that target private insurers, as well. There are numerous types of behavior that may lead to a healthcare fraud case, including theses:
  • False claims made to Medicaid
  • False claims made to Medicare
  • Upcoding
  • Unbundling
  • Overbilling for services
  • Taking kickbacks
  • Billing for name-brand medications while giving generics to patients
  • Charging for one service, then performing another
  • Billing for services that were never provided
  • Billing for medical supplies or equipment that were never purchased

Since there are various kinds of healthcare fraud, there are also specific laws designed to prosecute them. Some of these include the following:

The False Claims Act

The False Claims Act is a statute that originated during the civil war. At that time,  the government was victimized by a substantial amount of fraud from contractors who provided unusable or poor quality military supplies. The False Claims Act imposes liability on those who defraud the federal government. It also contains a provision that allows private citizens to become government whistleblowers who call attention to fraudulent behavior.

Prosecutors and Health Care Fraud

Prosecutors pursue healthcare fraud cases aggressively and intensively, as millions of dollars can be at stake. In some instances of prescription fraud, there may be an active stream of prescription painkillers getting into the hands of the public. Without proper maintenance and control, those painkillers could have devastating consequences, potentially leading to fatalities. Prosecutors do not take healthcare fraud lightly and work diligently to convict individuals who commit these crimes.

Healthcare Fraud Allegations

Healthcare fraud allegations may involve significant legal and professional consequences. These can have an enduring effect on an individual’s career and practice. Due to the complexity of many of the  federal laws, healthcare fraud charges may be brought against individuals who had only an indirect or peripheral involvement in the fraudulent activity. Having a healthcare fraud lawyer assess your liability may help you overcome fraud charges or mitigate the potential for penalties.