Healthcare Fraud

Posted By MatadorAdmin || 29-Oct-2022

While federal healthcare crimes can involve a wide array of charges and players, it frequently centers on  matters involving doctors, nurses, physician assistants, pharmacists and insurance companies. As with any other fraud in federal prosecutions, it involves a “scheme to defraud.” There are many scenarios where the Government alleges such schemes occur. Such as the following from a New Jersey healthcare fraud lawyer who residents trust, that works with our friends at LGR Law, LLC:

  • Government Health Insurance Fraud:  Medicare and Medicaid are both government administered health insurance programs.  Medicare provides health insurance for age eligible individuals while Medicare provides health insurance coverage for income eligible individuals. Sometimes physicians are accused of fraudulently billing these government programs by exaggerating services rendered (“upcoding”) or for services that were never actually rendered at all.
  • Prescription Drug Fraud:  These types of schemes involve physicians overprescribing pain medications (“pill mills”) or, in some cases selling drugs on the open market for profit. Some schemes involve “kickbacks” as well.
  • Medical Equipment Fraud:  In these types of schemes, “free” products are offered to individuals.  The insurers are then billed for products that were not needed or never delivered.
  • Rolling Lab Schemes:  Unnecessary and sometimes outright fake tests are given to individuals and then those tests are billed to insurers.

The main law which the government relies upon to pursue healthcare fraud charges is codified at 18 U.S.C. § 1347 and is plainly entitled “Health care fraud.”  Under this federal statute, a person that makes a false statement or a promise to defraud a health care program and who does so “knowingly or willfully” shall be guilty of a federal felony and can be punished by imprisonment of up to 10 years.  This is the most commonly used statute by federal prosecutors in pursuing healthcare fraud charges.

If you’re a health care provider accused of health care fraud, you have a lot to lose.  Having the right legal team in your corner is important. Contact an attorney today for help with your case!

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