Federal Medical Fraud Lawyer

Federal Medical Fraud Attorney

Federal medical fraud is considered a serious crime in every state. Sometimes, a person may be charged with healthcare or medical fraud even if they did not intend to do so. Navigating this legal terrain can be difficult and incredibly overwhelming. To ensure your rights are protected and that your story is heard, you should seek assistance from an experienced federal medical fraud lawyer as soon as possible.

Powerful Federal Medical Fraud Defense

At The Law Offices of Richard Kuniansky, we understand how to navigate the complexities of medical fraud allegations. We believe in fighting for your rights, no matter the charges against you. We can look at the evidence and circumstances surrounding your case while aiming to ensure that you are knowledgeable of your rights and process every step of the way so you can navigate the next steps with ease.

What Is Federal Medical Fraud?

The intentional use of dishonesty, false statements, or misrepresentation when filing medical claims is known as healthcare fraud. Healthcare fraud, which also goes by the name of federal medical fraud, is done with the intention of obtaining benefits or money illegally. Patients, insurance corporations, and healthcare providers can all be potential perpetrators of healthcare fraud.

Medicare and Medicaid, two public health insurance programs, are often the targets of fraud. Under these programs, providers that file false claims or engage in other deceptive tactics face harsh penalties under federal law, up to and including felony prosecution.

Examples of Healthcare Fraud

Healthcare fraud can happen in a number of different ways. It can be performed by healthcare providers, patients, pharmacists, and others.

Fraud by healthcare providers can look like:

• Double Billing. This occurs when a service is claimed more than once and a healthcare provider receives payment twice for the same service.
• Phantom Billing. Phantom billing occurs when a patient is billed for products or services that they never got.
• Unbundling. This happens when several invoices are sent for an identical service.
• Upcoding. This is the practice of billing a patient for a more expensive service than they really received.

Fraud by patients (and others) can look like:

• Phony Marketing. This occurs by persuading individuals to divulge their health insurance number and other private information in order to charge them for services that were never given, steal their identity, or sign them up for a fictitious benefit plan.
• Identity Swapping and Theft. If you allow someone else to attempt to use your health insurance or you steal another person’s to use as your own, this is medical fraud.
• Posing as a Medical Professional. It is illegal to identify as a medical professional when you are not. If you attempt to perform services or charge for services for which you do not have the proper license, this is healthcare fraud.

Fraud by pharmacists or others looking to utilize prescription drugs under false pretenses can look like:

• Forgery. This includes making or using fake prescriptions. This could be for personal use and consumption, to feed reliance or addiction, or to sell to others for personal gain.
• Diversion. This is the practice of using legitimate prescriptions for illicit purposes, including selling your prescription drugs.
• Purchasing medical care. This is obtaining prescriptions for prohibited medications from several physicians or from medical offices that use unethical techniques.

Defenses to Medical Fraud

In order to defend against accusations of medical fraud, an attorney must refute the prosecution’s evidence and show that the accused acts do not fit the legal definition of fraud. Common defenses include:

• Lack of Intent. This makes the case that any actions were accidental and that there was no intent to defraud.
• Error or Mistake. This demonstrates that inaccuracies in billing were the result of administrative mistakes instead of intentional deceit.
• Lack of Knowledge. This makes the claim that the defendant was unaware of the fraudulent action.
• Valid Documentation. This offers proof that the services were rendered and medically necessary, as well as demonstrating that the billing procedures followed legal guidelines.
• Statute of Limitations. The defense can claim that the statute of limitations is up and prevents the filing of charges.
• Entrapment. This is making the claim that law enforcement coerced the defendant into committing the fraud.

Each medical fraud case is different, and these defenses’ effectiveness varies according to the particulars of each case. A knowledgeable defense lawyer will evaluate the situation, compile evidence, and create a plan of action designed to refute the prosecution’s position and protect the defendant’s rights.

It’s critical to distinguish fraud from mistakes or errors in administration. While errors could be the consequence of unintentional billing errors or administrative oversights, fraud involves deliberate deceit for financial gain. Talk to a lawyer to better understand the exact details of your charge and what your options may be moving forward.

FAQs

What Are Three Examples of Medical Fraud?

Three examples of medical fraud include billing for services not provided (such as treatments or procedures that were never performed), falsifying medical records (such as adding a record to justify a procedure being done to receive higher compensation), and kickback for patient referrals (including accepting payments for referring patients to specific providers).

What Is the Difference Between Malpractice and Fraud?

The difference between malpractice and fraud is that malpractice occurs when a healthcare provider’s professional negligence results in subpar care that harms a patient. On the other hand, fraud is the deliberate deception or misrepresentation for monetary benefit. Fraud is an intentional attempt to deceive or exploit for profit, whereas malpractice is the failure to provide the required level of care.

What Is the Difference Between Medical Fraud and Negligence?

Fraud involves intentional deception or misrepresentation to receive unfair or unlawful financial or personal gain. It is an intentional action generally used to take advantage of someone. Negligence, on the other hand, refers to the failure to exercise reasonable care, resulting in unintentional harm to another party. Negligence is generally done by carelessness or omission rather than an intent to deceive.

Is Medical Fraud the Same as Abuse?

Medical fraud refers to deliberate deception to receive unauthorized compensation, such as creating false records or invoicing for services that are not provided. Abuse refers to actions that deviate from recognized medical or corporate norms, resulting in avoidable expenses. However, they may not always entail intentional dishonesty. Fraud is purposeful. Incorrect practices can lead to abuse even when there is no intention of defrauding. These two acts are not the same.

Contact The Law Offices of Richard Kuniansky for Assistance

If you have been charged with federal medical fraud, The Law Offices of Richard Kuniansky can help. Our team is passionate about listening to our clients and fighting for their rights. Contact us today to learn more about how we may be able to help you.