False Claims Act Federal HealthCare Fraud Defense Lawyers
Criminal Defense Attorneys HealthCare Fraud Defense Lawyers: Aggressive Legal Representation for Providers, Businesses, Administrators Nationally. Call us immediately if you have never intended to defraud the federal government and are under investigation.
Facing federal health care fraud and False Claims Act allegations can be stressful and scary. Even when you make an honest mistake, federal prosecutors and federal agents generally only care about one thing. Indicting or getting a conviction at trial with allegations of fraud in the healthcare industry.
If you are at the investigation stage, you cannot afford to wait to see how the “case plays out.” By that time, the prosecution had already been targeting you. You are now faced with playing catch-up to protect your rights.
Government Investigations | HealthCare Fraud Whistleblower Defense Strategies | Subpoenas & Civil Investigative Demands (CIDs) | FBI, HHS, Office of the Inspector General (OIG) and DOJ Investigations | Indictments | Medical Billing Fraud Defense | Federal Criminal Defense & Trials | Corporate Compliance | Internal Investigations | Health Care Fraud Investigations Defense
We develop a sound legal team up front to fight back: We work with local counsel across the United States to investigate, plan and execute a tailored legal defense to your healthcare fraud case. We provide effective and experienced legal services to medical providers and suppliers dealing with the complex and potentially crippling risks associated with fraud and abuse investigations and prosecutions.
What is Health Care Fraud?
Healthcare fraud typically involves a scheme to defraud the federal healthcare program. The government’s case may tend to argue false or fraudulent representations in exchange for money – payment of invoices or something of value. The key to defending a healthcare fraud case is to show a lack of intent. This is usually the government’s biggest hurdle in a criminal case and something that a medical fraud defense attorney at our firm can help with. A false claims case can start with a simple mistake, unintentional billing errors or some other error. The government must prove intent to defraud. As your medical defense attorney, we build a solid defense team to fight back with the goal of forcing the federal government to dismiss or settle the matters
At Watson & Associates, LLC, our federal health care fraud lawyers and criminal defense attorneys healthcare fraud professionals represent federal clients nationwide. As a national healthcare fraud law firm, we build a team specifically for your case and aim to get the case or charges dismissed as early as possible. If that fails, we are prepared to aggressively represent you at trial.
Your Lack of Intent is Critical to Winning a HealthCare Fraud Case
Federal Healthcare fraud allegations require the government to prove specific elements. Defenses for healthcare fraud depend on the facts of your case. For example, to be found guilty of fraud, the prosecution would have to show that you acted knowingly.
Lack of knowledge or even intent can be a strong defense with the right medical fraud defense attorney on board.
Have You Been Served With a Civil Investigative Demand Alleging Healthcare Fraud?
Federal law enforcement agencies use different approaches to investigate health care fraud. Typically, prosecutors will allege False Claims Act Health Care Fraud violations and will issue you a Civil Investigative Demand (CID), or a subpoena in a criminal case. The CID is used up front to force you to provide a multitude of documents to the government. However, having a CID lawyer to help sift through the documents or testimony that can incriminate you is essential.
We help you minimize your exposure to criminal or civil liability health care fraud cases involving violations of the Anti-Kickback Statute, the False Claims Act, and Stark Law.
Nationwide Criminal Defense Attorneys and Healthcare Fraud Defense Lawyers for Health Care Providers, False Claims Act Private Lawyers for Pharmaceutical Companies, Manufacturers, and More
Has the federal government knocked on your door and issued you a subpoena or civil investigative demand that alleges False Claims Act violations? Are you more worried that our system of “innocent until proven guilty” will fail?
You are not alone. Unfortunately, healthcare providers, pharmaceutical company facilities, and suppliers are frequently targeted primarily by a healthcare fraud whistleblower’s phone call on baseless allegations. Hiring a healthcare fraud lawyer can be a substantial benefit.
At Watson & Associates, LLC, our criminal defense and health care fraud attorneys. represent and defend companies and individuals nationwide. We aim to dispel any weaknesses in the government’s case – From health care fraud investigation through indictment and trial.
See the video below to get more critical information defense tips:
What Are Examples of HealthCare Fraud?
Examples of common healthcare False Claims Act fraud charges may include:
- Falsifying certificates of medical necessity in order to bill services
- Upcoding and unbundling
- Falsifying plans of treatment or medical records to justify payments
- Misrepresenting diagnoses or procedures to maximize payments
- Soliciting “kickbacks” for the provision of various services or goods
- Falsifying claims
- Unlawful prescribing and dispensing
See Information About Your Legal Defenses to a HealthCare Fraud Case
What are Federal Healthcare Fraud Charges?
As part of the health care industry, you can be exposed to civil and criminal statutes that government how business is conducted. See some of the common ones below. You can be demanded to respond to either a false claims act civil investigated demand for healthcare fraud.
Criminal Health Care Fraud
(18 U.S.C. § 1347) – To prove criminal healthcare fraud, the federal prosecutors must show that you knowingly and purposefully 1) executed a scheme to defraud a health care benefit program or 2) used false statements to obtain funds held by federal health care programs (Medicare, Medicaid).
Anti-Kickback Statute
(42 U.S.C. § 1320a-7b) – To prove criminal anti-kickback charges, the government must provide evidence that you knowingly and purposefully 1) offered or received anything of value and 2) it induced or rewarded referral of Medicare or Medicaid business.
False Claims Act
(18 U.S.C. § 287) – To prove criminal charges for false claims, the government must provide evidence that the defendant knowingly and purposefully 1) made a claim or statement to get the government to pay money on a claim and 2) that the claim or statement was false or fraudulent.
False Claims Act (31 U.S.C. § 3729) – The government can also bring a civil claim for false claims violations as noted above. It also allows a private citizen or whistleblower to bring a case on behalf of the government.
Stark Law – Physician Self-Referral Law
(42 U.S.C. § 1395nn, 42 CFR Subpart J) – In contrast to the Anti-Kickback Statute, the Stark Law is not a criminal statute. However, like the False Claims Act, the government may bring civil charges under Stark Law. To pevail, the government is does not have to show intent, which means that even accidental or unknowingly violations can subject a medical practitioner to substantial civil penalties.
Self-referral violations require proof that the defendant 1) made a referral for health services to an entity the physician (or immediate family) has a financial relationship and 2) the entity submitted a claim for payment resulting from the referral. “Financial relationship” is interpreted broadly to include direct, indirect, ownership or investment as well as immediate family financial interests.
Health Care Fraud Conspiracy
(18 U.S.C. § 1349) – To prove health care fraud conspiracy, the prosecutor has to show evidence that 1) two or more people agreed to a common plan, 2) the defendant knew the unlawful purpose, and 3) joined willingly with the intent to further the unlawful purpose. The plan does not have to be successful to be convicted of this crime. While there are several different conspiracy laws that may apply in health care fraud, this is the one we see prosecutors use most often.
Wire and Mail Fraud
(18 U.S.C. § 1341, 18 U.S.C. § 1343) – To prove wire or mail fraud, the government must provide evidence that 1) there is a scheme to defraud, 2) U.S. mail was used in the scheme or 3) interstate telephone or electronic communications were used to further the scheme. These laws cover all types of fraud, not just health care fraud. Although these laws cover similar conduct as the Health Care Fraud statute, prosecutors like to use these offenses to threaten a defendant with lengthier sentences. Call our health care fraud defense attorney for immediate help.
What are the Potential Outcomes If You Are Investigated for Healthcare Fraud?
If you or your company is being investigated for healthcare fraud, your immediate goal is to get the matter resolved, or the investigation ended before any charges or indictments evolve. Your case becomes more difficult if you are indicted/charged for healthcare fraud. Agencies that tend to bring civil or criminal charges for healthcare or medical billing fraud include the U.S. Department of Justice (DOJ), (OIG), Drug Enforcement Administration (DEA), Medicaid Fraud Control Unit, U.S. Department of Health and Human Services Office of Inspector General, and Federal Bureau of Investigation (FBI) include:
- Termination of the investigation without civil or criminal charges
- Civil charges under the False Claims Act, Anti-Kickback Statute, Stark Law, and/or other federal healthcare fraud statutes
- Grand jury indictment and criminal prosecution
Is It Worth Opening Yourself to Jail Time or Paying $1.9 Million to Settle Allegations of Fraudulent Billing? Our Health Care Fraud Defense Attorney Can Help. See this Case.
Types of Health Care Fraud Defense Cases We Handle
Our Federal HealthCare Fraud law firm and Criminal Defense Attorneys Healthcare Fraud Law Firm Represents Clients in a Variety of Fraud Case including:
- Billing for unnecessary medical services
- Billing for services not provided
- Upcoding claims – submitting claims that are higher than the level of service provided for higher reimbursement
- Unlicensed medical services
- False certification
- Duplicate claims of fraud in healthcare industry
- Misrepresenting diagnosis or procedure to capitalize on maximum profits
- Unbundling procedures – serrating costs for procedures normally billed as one kind of treatment
- Altering medical records or reports
- Healthcare overpayment defense
- Healthcare fraud whistleblower defense lawyers
- Receiving kickbacks for any goods or medical services under the Anti kickback Statute
- Federal Conspiracy defense See 18 U.S.C. 1349)
Call our qui tam attorneys and federal health care fraud lawyers today for a Free Initial Consultation at 1.866.601.5518. Speak to Theodore Watson.
Nationwide Legal Defense
Our federal healthcare fraud lawyers can provide legal defense in most states including Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Utah, Vermont, Virginia, Washington, Washington, DC, West Virginia, Wisconsin, and Wyoming.
Cities in which our False Claims Act federal health care fraud lawyers assist manufacturers, hospitals, providers, and CEOs include Anchorage, AK; Atlanta, GA; Austin, TX; Chicago, IL; Colorado Springs, CO; Dallas, TX; Denver, Colorado; Indianapolis, IN; Las Vegas, NV; Los Angeles, CA; Miami, FL; Philadelphia, PA; San Antonio, TX; San Diego, CA; San Francisco, CA; San Jose, CA; Santa Clara, CA; and Tampa, FL.
Help Responding to Healthcare Fraud False Claims Act Civil Investigative Demands (CIDs) and Subpoenas
A large portion of healthcare fraud cases stems from allegations that medical providers or healthcare businesses (labs, pharmacies, hospitals, and home healthcare agencies) submitted fraudulent billing claims. Department of Health and Human Services (HHS) or DOJ or some other law enforcement agency may serve you with a civil investigative demand (CID) or subpoena (in criminal cases). We look at documents to see if there are potential opportunities to get the investigation thrown out. Most healthcare fraud false claims act cases focus on what could be a billing error and not the government’s allegations that your healthcare service lacked medical necessity, was outside the accepted standards of care (e.g., excessive testing), was billed too high, or was billed for but not provided.
Our health care fraud defense attorneys will aggressively help respond to civil investigative demands and or Grand jury subpoenas issued by the agency or Department of Justice (DOJ)
Medical Billing Fraud Defense & False Claims Act Health Care Fraud Lawyers
Nationwide healthcare fraud defense lawyers: You have worked hard to grow and scale your business in the competitive and highly regulated healthcare industry. You have tried your best to comply with the rules. Yet, you have now received word that you are being investigated or indicted for what is more than likely a billing mistake.
For an industry that is highly regulated, you need federal health care fraud lawyers to get to the bottom of the allegations and immediately start preparing your legal defense. The government attorneys or prosecutors will more than likely claim that your bills were too high, that you billed for care that was not provided, or that you conducted excessive testing. Our medical billing fraud defense attorneys and federal health care fraud lawyers can help.
False Certifications When Submitting Bills
Medical physicians, hospitals, and other medical providers must provide certain legal certifications when submitting invoices to the federal government healthcare programs. These healthcare certifications include medical necessity, actual performance, and regulatory compliance. In addition, providers that provide goods or services to government healthcare programs must satisfy all contractual obligations with the government. If you do not, in good faith, certify these medical invoices and intend to get your claims paid or certifications to obtain additional business, you could be civilly or criminally liable for healthcare fraud and may also be a violation of the False Claims Act. Watson’s HealthCare False Claims Act defense attorneys can help. Call today at 1.866.601.5518. Speak to Theodore Watson or Send Him an Email.
What are the Elements of Health Care Fraud 18 U.S.C. Section 1347
The legal elements of a federal health care fraud case depend on if the charges are civil or criminal in nature. For example, in federal criminal healthcare fraud cases, the elements of health care fraud under 18 U.S.C. Section 1347 are:
(1) Knowingly and willfully
(2) executing, or attempting to execute, a scheme or artifice
(3) to defraud a health care benefit program or obtain funds from a health care benefit program under false pretenses
(4) in connection with the delivery of, or payment for, health care benefits, items, or medical services.
18 U.S.C. Section 1347 also allows federal prosecutors can also pursue civil or criminal healthcare fraud charges under the Anti-Kickback Statute.
Federal Health Care Fraud Investigations by FBI, DOJ, or OIG Offices
HealthCare Fraud Defense Lawyers Responding to Civil Investigative Demands (CID)
Nationwide healthcare defense attorneys: Responding to OIG or DOJ civil investigative demands or CIDs can be overwhelming. We ensure timely and accurate responses, reducing potential penalties and safeguarding your interests. Our medical fraud case attorneys can help with Trade Agreements Act Compliance With Medical Equipment Sold to the Government and product substitution False Claims Act criminal investigations.
Selling medical equipment to the government? Our healthcare fraud defense lawyers ensure that your sales practices align with the Trade Agreements Act, preventing unnecessary legal entanglements.
Healthcare Overpayment
Allegations of medical billing fraud and overbilling can tarnish reputations. As healthcare enforcement action defense attorneys and health care fraud attorneys, we focus on scrutinizing the evidence, verifying billing records, and negating wrongful allegations by federal prosecutors.
Our healthcare overpayment defense lawyers and healthcare enforcement action defense lawyers provide experienced and knowledgeable representation in federal medical billing fraud charges, helping to ensure your rights are protected when facing charges about over-billing private insurance companies.
Medical Billing Fraud
Some of the more common forms of Medical billing fraud occur when there is upcoding, unbundling, and billing for services that were not provided.
There are many other types of health care fraud schemes. At Watson & Associates, LLC our medical billing fraud defense lawyers and defense attorneys will work with you or your organization, bring in the experts analyze, and plan for your legal defense.
The federal government will only pay for medical services performed or for equipment that is delivered. When federal prosecutors allege medical billing fraud, it will come in the form of as each instance that you billed the Government as a separate False Claims Act violation.
If you are subjected to a Qui Tam or Whistleblower case for medical billing fraud our federal health care fraud lawyers are ready to provide immediate help.
Speak with Theodore Watson today for immediate help. Call 1.866.601.5518.
Our Featured Civil and Criminal HealthCare Fraud Defense Lawyers
- Experience: Theodore has served federal government contracting agencies as a seasoned practice group lead.
- Expertise: His understanding of the DOJ, SBA OIG, and the intricacies of how civil or criminal cases are built against you makes him a top choice for assessing your case and developing a sound legal strategy.
- Expertise: From procurement fraud to Anti Corruption law, and the False Claims Act, Wise’s litigation experience is unparalleled.
- Former Navy officer with years of experience in criminal defense.
We also work with local counsel as part of our team build and defense strategy.
Walter H. Foster , Esquire. Of Counsel, is a seasoned criminal defense attorney and former Army colonel with deep experience orchestrating teams, imparting clarity and counsel, and executing on behalf of both private enterprise and the federal government.
Moving to the Pentagon as Lead Trial Counsel, Walter was tapped to spearhead the high-profile prosecution of an Al Qaeda operative who had been detained at Guantanamo Bay. Walter has the federal experience on the other side that can help health care fraud clients nationwide.
Health Care Fraud Investigation Defense Lawyer
Understanding 31 U.S.C. 3729 et seq: You might have heard of the False Claims Act (FCA), a rigorous federal law designed to prevent fraud against the government. If someone accuses you of medical fraud, it’s probably because they think you intentionally made up false claims. The purpose of making up these false claims is to get money from the government.
Having healthcare fraud attorneys experienced in the Federal False Claims fraud statute to guide you through the investigation and prosecution stages will be essential for fair treatment under the law and for protecting your constitutional rights in healthcare fraud investigations defense.
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Contact Our False Claims Federal HealthCare Fraud Attorneys for Immediate Help
Protect Your Future with Watson & Associates’ healthcare fraud defense lawyers: For a confidential, no-cost initial consultation with one of our federal health care fraud lawyers, contact the best criminal defense lawyers and health care fraud attorneys at Watson & Associates. Call 1-866-601-5518. Your defense, from coast to coast. Speak to Theodore Watson.