Jennifer Horwitz Law provides well-conceived defense strategies to clients who have been accused of healthcare fraud. Despite federal and state laws governing the healthcare system, healthcare fraud is commonplace in Washington State. From fraudulent billing practices to administering unnecessary services to accepting kickbacks, healthcare fraud is a serious offense that is punishable by imprisonment and fines.
If you are a healthcare provider who is facing healthcare fraud charges, you need the powerful representation Jennifer Horwitz provides. Jennifer is well-versed in the applicable healthcare fraud statutes and will fight hard to protect your freedom and your professional reputation. Contact her office in Seattle today to schedule a consultation.
What is healthcare fraud?
Healthcare fraud is a type of white-collar crime that centers on submitting false or misleading information to a health insurer, Medicare, or Medicaid to recover payment for services. This is not a victimless crime because fraud results in significant financial losses that are subsequently passed on to consumers in the form of higher insurance premiums.
Healthcare fraud can be committed by medical professionals seeking to profit financially by:
- Billing for services and procedures that were not actually performed
- Billing for a different, more expensive service than what was provided (upcoding)
- Billing each step of a procedure as a separate procedure (unbundling)
- Providing a service not covered by insurance, then billing for a covered service
- Accepting kickbacks for patient referrals or for certain drugs or treatments
- Forging a prescription
While these activities are illegal, there is a difference between healthcare fraud and legitimate mistakes. Mistakes can occur if a medical professional omits information from a bill or generates an inaccurate bill inadvertently, while healthcare fraud involves the intent to defraud.
In short, a healthcare provider who knowingly submits bills to an insurance company for services not provided or takes part in other fraudulent activity may be charged with healthcare fraud. To gain a conviction, however, the prosecution must be able to prove the defendant’s intent beyond a reasonable doubt.
Federal and Washington State Laws Prohibit Healthcare Fraud
Healthcare fraud is a violation of a number of federal and state laws, including:
False Claims Act
The False Claims Act (FCA) is designed to protect the federal government against fraud. In particular, the qui tam provisions of the FCA allow individuals and entities (relators) with evidence of fraud against federal programs (e.g, Medicare) to file a lawsuit against the wrongdoer on behalf of the government. A relator or whistleblower may be awarded a portion of the funds recovered by the government.
This law prohibits a medical provider from receiving anything of value – a kickback – in exchange for referring patients to Medicare or other federal healthcare programs. Examples of illegal kickbacks include:
- Payment for referrals
- Free or low-rent office space
- Excessive compensation for medical directorships
The Anti-Kickback Statute imposes civil penalties of up to $50,000 per violation (plus three times the amount of any overpayment), as well as criminal penalties, including up to 5 years in prison and fines up to $25,000.
Stark Law (Physician Self-Referral)
Doctors are barred from referring Medicare patients for certain healthcare services to any entity in which the physician has a financial relationship. This includes not only any direct or indirect compensation arrangement but also financial interests held by the doctor’s immediate family members. A conviction for a violation of the Stark Law can result in civil penalties of $15,000 for each prohibited referral.
Criminal Health Care Fraud Statute
This federal law prohibits any person from intentionally and knowingly defrauding any healthcare program, such as making false statements to obtain payments.
Washington State Medicaid Fraud False Claims Act
This state law, modeled after the federal FCA, allows whistleblowers to file qui tam lawsuits if they know of persons or entities who intentionally submit false or fraudulent claims to the state Medicaid program. Violators may be required to pay up to three times the actual damages to the state, plus civil fines for each violation.
Defenses Against Healthcare Fraud
The penalties for healthcare fraud are severe, and a conviction can also result in your medical license being revoked. When your freedom and your future are in jeopardy, turn to Jennifer Horwitz Law. Although state and federal prosecutors have an unfair advantage over defendants, our experienced healthcare fraud defense attorney will level the playing field and choose the best line of defense.
Jennifer Horwitz will work to exploit weaknesses in the government’s case against you and argue that there is insufficient evidence for a conviction. Jennifer will also determine whether law enforcement violated any of your civil rights through improper surveillance tactics or invalid search warrants and ask the court to suppress any evidence that was obtained improperly.
One of the strongest defenses against healthcare fraud charges is that you made a bona fide mistake such as inadvertently omitting information, billing improperly, or making a payment error. In addition, it may also be possible to show that you did not know, or were not capable of knowing, that you had engaged in healthcare fraud. Although we are committed to winning an acquittal, we may seek to have the charges and penalties reduced, depending on the strength of the evidence against you.
Contact Our Experienced Seattle Healthcare Fraud Attorneys
Jennifer Horwitz Law has a demonstrated track record of successfully defending medical professionals against healthcare fraud in federal and state court. Above all, Jennifer will work in your best interests at all times and make sure your rights are protected. Contact her today to schedule a consultation.