Despite federal and Washington State laws governing the healthcare system, healthcare fraud remains a common occurrence. Law enforcement agencies investigate allegations ranging from administering unnecessary services and fraudulent billing practices to identity theft. The penalties for healthcare fraud can include significant fines and substantial prison sentences.
At Jennifer Horwitz Law, we represent individuals and medical professionals accused of or under investigation for healthcare fraud. Our founder, Attorney Jennifer Horwitz, has more than 30 years of experience in criminal law. She is well-versed in healthcare fraud statutes and provides aggressive defense to protect your professional reputation and freedom.
Contact Jennifer Horwitz Law today to schedule a confidential consultation with an experienced Seattle healthcare fraud defense attorney.
How Jennifer Horwitz Law Can Help You Fight Allegations of Healthcare Fraud in Seattle, WA
Are you accused of healthcare fraud in Washington State? When you hire our top-rated Seattle criminal defense attorney, you can trust that we will:
- Promptly assess your risk, including intervening in the government’s investigation to quickly determine the allegations against you
- Conduct an independent investigation to gather additional evidence and uncover information that may be crucial to your defense
- Analyze the documents, evidence, and other information related to your case to identify potential weaknesses in the prosecution’s case
- Assist you and your team in making informed decisions to help you avoid critical mistakes that could hurt your defense
- Engage qualified experts to assist during the investigation and provide testimony when necessary
- Develop an effective and proactive defense strategy based on the unique circumstances and evidence in your case
- Work diligently to secure a discreet and efficient resolution through negotiation and mediation to protect your professional reputation and practice
- Be fully prepared in case your case goes to trial to fiercely present a defense to the allegations of healthcare fraud
Jennifer Horwitz has received top ratings and recognition from local and national organizations. Expertise.com named her one of the Best Criminal Defense Attorneys in Seattle in 2022. She is a Harvard Graduate who has been named one of the Top Women Attorneys of 2024 by Super Lawyers and Seattle’s Best Lawyers by Forbes.
Call Jennifer Horwitz Law to schedule a confidential consultation with a Seattle healthcare fraud defense lawyer. We’ll help you navigate investigations and prosecutions by leveraging our extensive experience to protect your rights and interests.
What Is Healthcare Fraud in Washington State?
Healthcare fraud is a white-collar crime designed to defraud a healthcare program by accessing something of value, usually money. It typically involves providing false or misleading information to health insurers, Medicaid, or Medicare. Common examples of healthcare fraud include, but are not limited to:
- Upcoding services involve submitting claims for healthcare services that are more serious or expensive than what was actually performed.
- Kickbacks involve knowingly and willfully receiving, paying, soliciting, or offering compensation for referrals for goods and services payable to a government healthcare program.
- Billing for ghost patients who do not exist or have never received the service or item billed for in the claim.
- Inflating cost reports to Medicare for reimbursement of certain costs for the treatment of certain types of patients.
- Billing for services not rendered by submitting claims for healthcare services that were never performed.
- Unbundling involves billing separately for services that should be billed as a single service.
- Identity theft involves stealing or using another person’s identity to obtain services or reimbursement.
- Billing for medically unnecessary services or treatments, including diagnostic tests, treatments, medical devices, etc.
Numerous agencies investigate healthcare fraud in Seattle. State investigative agencies include the Medicaid Fraud Control Unit of the Washington State Attorney General, the Office of the Insurance Commissioner’s Criminal Investigations Unit, and the Washington State Department of Social and Health Services Office of Fraud and Accountability.
At the federal level, healthcare fraud may be investigated by the U.S. Dept. of Health and Human Services’ Office of the Inspector General, the U.S. Department of Justice, and the Centers for Medicare and Medicaid Services. The FBI, IRS, and DOD may also be involved in some healthcare fraud investigations.
What Are the Penalties for Healthcare Fraud in Seattle, WA?
The penalties for healthcare fraud include criminal and civil punishments. A party may also experience one or more collateral consequences. Penalties vary depending on the nature of the offense, but can include:
- Imprisonment ranging from several months to several years
- Fines that could total thousands or millions of dollars
- Orders to pay restitution to victims
- Professional consequences, including suspension or revocation of professional licenses
- Damage to a person’s personal and professional reputation leading to a loss of trust among patients, colleagues, and the community
The best way to defend yourself against charges of healthcare fraud is with the informed representation provided by Jennifer Horwitz Law. We are committed to obtaining an acquittal. Should a conviction occur, we will passionately advocate for you during the sentencing phase by presenting a compelling argument for reduced penalties or alternative sentencing options.
Federal and Washington State Laws Prohibit Healthcare Fraud
Healthcare fraud is illegal under numerous state and federal laws. Healthcare fraud laws encompass statutes related to false statements, fraudulent insurance claims, and theft. Federal and state laws that govern healthcare fraud include:
- Washington Code §74.09.230 makes it a crime to knowingly use deception or make false statements related to medical programs.
- The False Claims Act (FCA) protects the federal government against fraud against federal healthcare programs (i.e., Medicare). It allows individuals and entities with evidence of fraud to file a lawsuit against the wrongdoer on behalf of the government.
- The Anti-kickback Act prohibits medical providers from receiving anything of value in exchange for referring patients to federal healthcare programs.
- Federal Code 18 USC §1347 prohibits willfully and knowingly executing a scheme or attempting to execute a scheme to defraud a healthcare program.
- The Stark Law prohibits doctors from referring Medicare patients for certain services to any entity in which they have a financial interest. It is also known as the Physician Self-Referral law.
- The Washington State Medicaid Fraud False Claims Act allows whistleblowers to file lawsuits on behalf of the government against individuals or entities who submit fraudulent claims to the state Medicaid program.
The specific law used to charge a person or entity with healthcare fraud depends on the circumstances of the case. The penalties for a conviction may vary depending on the specific law being used to bring charges.
Defenses Against Healthcare Fraud in Washington State
Several defense strategies can be employed when facing charges of healthcare fraud. Intent is a critical factor in many healthcare fraud cases. The government must prove that you acted with the intent to deceive or cheat another party with the goal of financial gain. However, there is a difference between having an intent to commit fraud and making an honest mistake or error.
At Jennifer Horwitz Law, our legal team chooses the best line of defense based on the charges against you, the factors involved in your case, and other circumstances. Potential defenses to healthcare fraud include:
Lack of Intent
We use evidence to demonstrate that the alleged fraud was the result of misunderstandings or unintentional errors, rather than intentional deception.
Insufficient Evidence
Our attorney challenges the prosecution’s evidence and arguments to show that the government has failed to meet the burden of proof required for a criminal conviction.
Compliance
We argue that you adhered to the accepted industry standards and practices, and that any deviations were either justified or unintentional.
Entrapment
In rare cases, we may argue entrapment as a defense. This defense strategy involves proving that a government agent or law enforcement officer coerced or induced you into committing healthcare fraud.
In addition to the above defenses, our legal team analyzes all aspects of your case to determine if the government or law enforcement officers violated your civil rights. Violations of rights may include unlawful searches and seizures, as well as improper surveillance tactics. Our attorney files a motion to suppress evidence that was obtained in an illegal manner.
Contact an Experienced Seattle Healthcare Fraud Attorney
Facing healthcare fraud charges is an extremely serious matter, regardless of your role in the healthcare industry. Failing to seek legal advice when facing criminal charges could result in exposure to significant civil and criminal penalties.
Jennifer Horwitz Law has an impressive track record of successfully defending medical professionals and other parties against healthcare fraud in federal and state courts. Contact Jennifer today to schedule a consultation with an experienced Seattle healthcare fraud defense lawyer.