Healthcare Fraud Defense Lawyer
Nicholas G. Matassini is Board Certified in Criminal Trial Law. Contact us today for a free, confidential consultation. We offer virtual, telephone, and in-person meetings 7 days a week.
Our Bay area firm specializes in healthcare fraud defense in both State and Federal courts. We have a proven record of success defending individuals and organizations facing Medicare Fraud, false claims, and kickback fraud cases in Florida and across the country.
At the Matassini Law Firm we understand the complexities and nuances of healthcare fraud cases. These can involve allegations of false billing, kickbacks, and other fraudulent activities related to medical insurance claims. We also understand the severe penalties that can be imposed on individuals and organizations found guilty of healthcare fraud. These include fines, imprisonment, loss of professional licenses and damage to their reputation. Our healthcare fraud defense lawyer can help you navigate the complex, high-stakes landscape of healthcare fraud accusations with the ultimate goal of preserving your rights and achieving the best possible resolution in your case.
Defining Healthcare Fraud at the State vs. Federal Level
Healthcare fraud involves the intentional deception or misrepresentation of information related to the provision of healthcare services or products for financial gain. Healthcare fraud can occur at both the state and federal levels. It can involve a wide range of actors, including healthcare providers, telemarketing companies, patients, and insurance companies.
In Florida, healthcare fraud is generally defined as the fraudulent billing or receipt of payment for healthcare services or products that were not provided or were provided improperly; Medicaid fraud is also prosecuted at the state level. Examples of healthcare fraud in Florida may include:
- Billing for services that were not performed
- Misrepresenting the level of care provided to patients
- Providing unnecessary medical services to patients for financial gain
At the federal level, healthcare fraud, and Medicare fraud, is prosecuted under a variety of laws. This includes the Anti-Kickback Statute (also known as the Stark Law). Healthcare fraud under federal law may involve activities such as:
- Billing for services that were never provided
- Providing kickbacks to patients or other providers in exchange for referrals
- Engaging in fraudulent schemes to maximize reimbursements from Medicare
Federal Healthcare Fraud Legislation
Healthcare fraud is a serious offense that is addressed by a variety of federal laws, including:
- Conspiracy to Commit Healthcare Fraud: This applies when one or more people make an agreement to commit healthcare fraud together; this can occur between medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits.
- Wire Fraud: This applies when someone uses some type of wire communication to cheat someone out of money.
- Anti-Kickback Statute (AKS): The AKS prohibits the offering or receipt of anything of value in exchange for patient referrals. It also prohibits doctors from inducing the purchase of items or services paid for by government healthcare programs.
- Stark Law: The Stark Law bars physicians from referring patients to any organization in which they have a financial interest. This applies to certain designated health services covered by Medicare and Medicaid.
- Federal Food, Drug, and Cosmetic Act (FDCA): The FDCA prohibits the distribution of adulterated or misbranded drugs or medical devices.
- Racketeer Influenced and Corrupt Organizations Act (RICO): RICO allows for the prosecution of individuals or organizations engaged in a pattern of criminal activity, including healthcare fraud.
- False Claims Act (FCA): This law prohibits individuals or companies from submitting false or fraudulent claims for payment to government healthcare programs. These include Medicare or Medicaid.
These are just a few examples of the federal laws that healthcare fraud can be prosecuted under. The government takes healthcare fraud very seriously. Those found guilty can face significant fines and even imprisonment.
Understanding Different Kinds of Healthcare Fraud
There are distinct types of federal healthcare fraud. Some of the most common types include:
- Billing for Services That Were Not Provided: Healthcare providers may submit claims to Medicare or Medicaid for services that were never rendered. This is commonly known as phantom billing.
- Upcoding: Healthcare providers may intentionally misrepresent the services they provide to receive higher reimbursement rates.
- Unbundling: Healthcare providers may intentionally separate services that are usually performed together. They then bill them separately to increase their reimbursement rates.
- Kickbacks: Healthcare providers may offer or receive payments or gifts in exchange for referrals. This is illegal under the Anti-Kickback Statute.
- Stark Law Violations: Healthcare providers may violate the Stark Law. Under this law, physicians cannot make referrals for certain designated health services to entities in which they have a financial interest.
- False Certification: Healthcare providers may falsely certify that patients need certain services or treatments to receive reimbursement from Medicare or Medicaid.
- Pharmaceutical Fraud: This type of fraud includes activities such as promoting off-label use of drugs and overcharging for drugs. It also includes paying kickbacks to doctors who prescribe certain medications.
These are just a few examples of the diverse types of federal healthcare fraud. Each case is unique and may involve multiple types of fraud. If you are facing charges related to healthcare fraud, it is important to seek the guidance of an experienced Bay area healthcare fraud attorney. A delay could jeopardize your freedom.
Billing for Services Not Provided
Billing for services that were not provided is a form of healthcare fraud. It involves submitting claims for reimbursement to insurance companies or government healthcare programs for services that were not actually rendered to a patient. This type of fraud can occur in various settings, including hospitals, clinics, and doctor’s offices.
Billing for services that were not provided is prohibited by both state and federal laws, such as the False Claims Act. This imposes civil and criminal penalties for submitting false or fraudulent claims for payment to government healthcare programs such as Medicare and Medicaid. The Anti-Kickback Statute and the Stark Law prohibit the trading of valuable commodities for patient referrals. They also prohibit the purchase of items or services paid for by government healthcare programs.
Stark Law Violations
The Stark Law, or the Physician Self-Referral Law, involves the referral of services that are paid for by Medicaid and Medicare. It prohibits medical providers from referring their patients to entities in which they have a financial interest. Violations of the Stark Law can occur in many forms, including:
- Self-Referral: A physician refers a patient to a healthcare entity in which the physician has an ownership or investment interest for designated health services.
- Financial Arrangements: A physician has a financial relationship with a healthcare entity that provides designated health services. This can involve an ownership or investment interest, as well as compensation arrangements. The physician then refers patients to that entity for these services.
- Improper Billing: A healthcare entity bills Medicare or Medicaid for designated health services. However, they were referred by a physician who has a financial interest in the entity, in violation of the Stark Law.
Violations of the Stark Law can result in significant penalties, including fines, exclusion from government healthcare programs, and jail time. In addition, healthcare providers and individuals found guilty of Stark Law violations will be ordered by the court to pay back all the money they earned illegally.
Pharmaceutical Fraud
Pharmaceutical fraud is a type of healthcare fraud. It refers to the illegal and deceptive practices of pharmaceutical companies, their executives, and other individuals involved in the manufacturing, distribution, and sale of prescription drugs. Pharmaceutical fraud can take many forms, including:
- Off-Label Marketing: This occurs when a pharmaceutical company promotes a drug for uses that have not been approved by the U.S. Food and Drug Administration (FDA).
- Kickbacks: This occurs when pharmaceutical companies offer or provide illegal incentives to healthcare providers in exchange for prescribing their drugs.
- Price Gouging: This involves increasing the price of a drug beyond what is considered reasonable. Often, the offender is attempting to take advantage of a lack of competition or a captive patient population.
- False Claims: This involves submitting fraudulent claims for payment to government healthcare programs for drugs that were not medically necessary or were not actually provided to patients.
Pharmaceutical fraud can result in serious harm to patients. It also causes significant financial losses for government healthcare programs such as Medicare and Medicaid. In addition to civil and criminal penalties under the False Claims Act and other federal laws, pharmaceutical companies found guilty of fraud may also face damage to their reputation and decreased consumer trust.
Healthcare Fraud Defense
Healthcare fraud is a serious crime that carries severe punishments, such as:
- Fines
- Prison time
- Exclusion from government healthcare programs
- Loss of medical licenses or certifications
It is crucial to seek the advice of a skilled healthcare fraud defense lawyer if you are being accused of engaging in healthcare fraud. They can help you defend yourself and protect your rights.
A healthcare fraud defense attorney can assist you in many ways, including:
- Conducting an Independent Investigation: A healthcare fraud defense attorney can investigate the allegations against you. They can determine the strength of the government’s case and identify any weaknesses or inconsistencies.
- Developing a Defense Strategy: Based on the results of the investigation, a healthcare fraud defense attorney can develop a defense strategy. They can tailor it to the specific circumstances of your case.
- Negotiating a Plea Agreement: In some cases, it may be possible to negotiate a plea agreement with the government. This can reduce the charges or penalties in exchange for a guilty plea.
- Representing You in Court: If your case goes to trial, a healthcare fraud defense attorney can represent you in court, cross examine the government’s witnesses, present evidence in your defense, and fight to defend your rights.
- Providing Guidance and Support: A healthcare fraud defense attorney can provide you with guidance and support throughout the legal process. They can also help you understand your rights and options and answer any questions you may have.
If you are facing charges related to healthcare fraud, it is important to seek the guidance of an experienced healthcare fraud defense attorney as soon as possible. An attorney can help protect your rights and defend you against these serious charges. They can potentially minimize the penalties you face and help you move on with your life.
Defending the Accused in State and Federal Courts since 1976
Hire the law firm business executives, musicians, and politicians use when it’s all on the line. Consider a Board Certified Criminal Trial Attorney for your legal issues. When the stakes are high, there’s no room for trial and error. Choose a firm with a proven track record. Contact Nicholas G. Matassini right now for a free, confidential consultation.
