Healthcare fraud encompasses a broad scope of conduct aimed at criminalizing fraudulent acts of professionals and businesses in the health care industry. The majority of health care fraud cases stem from the fraudulent billing of Medicare or a state insurance program. Most doctors and health care businesses accept Medicare and state insurance from patients. By doing so, they promise to follow the extensive rules and regulations within those systems. These rules and regulations are an incredibly complex framework. This complicated framework often provides pitfalls for professionals, but also, provides legitimate defenses to criminal charges. As a general rule, the more difficult the law is to understand, the easier it is for your health care fraud attorney to challenge the willfulness element present in all health care fraud prosecutions.
Though health care fraud encompasses a huge amount of conduct, there are some general areas which account for the majority of prosecutions. Those areas are: 1) billing for medically unnecessary services, 2) upcoding services, 3) billing for services not rendered, and 4) kickback schemes.
Odom, Davis & Hobson – Health Care Fraud Attorneys
Our firm has represented numerous professionals and businesses that are being investigated for, or charged with, health care fraud. We understand health care fraud cases involve more than just a potential conviction and time in prison. These cases can greatly impact the client’s future through the loss of licensing and ability to make a living.
To protect our client’s interests, our firm conducts extensive investigations into all of our cases. Including hiring experts, speaking to staff members, and dissecting the regulatory provisions at issue. A health care fraud lawyer must have a sound understanding of the medical procedures and regulations to effectively defend the client. Our hope is to always forego criminal charges and save the professionals state license. However, if the professional does end up with formal criminal charges, we have a great track record in taking these cases before a jury.
In 2019, our firm was hired to represent a physician charged with health care fraud – billing for medically unnecessary procedures. The government alleged the client fraudulently billed Medicare for over $65 million dollars. The case went to trial in January of 2020. After two months of litigation, the judge found our client not guilty on all 25 counts alleged in the indictment. The client kept his medical license and can continue in his occupation. An in depth review of this case is located in three parts below.
If the government is investigating a health care fraud related matter, do not hesitate to contact us. We are prepared to help any professional through this process.
Our attorneys write various articles related to health care fraud defense. Those articles can be found at the Health Care Fraud Defense Blog.
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