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 fraud – false claims for reimbursement submitted to insurance providers, Medicare, or Medicaid
- Upcoding – billing for more expensive medical services or procedures than those provided
- Unbundling – billing separately for services that should be a single unit.
- Kickbacks – offering or receiving improper financial incentives in exchange for referrals or services
- False certifications – providing false information or certifications to obtain payments or approvals
- Identity theft – stealing or using another person’s identity to obtain healthcare services or reimbursement
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.
Healthcare Fraud Penalties
Healthcare fraud is a serious offense that can lead to severe consequences for medical professionals found guilty of such crimes. The penalties may vary depending on the nature of the offense but can include:
- Imprisonment – Convicted individuals may face significant prison sentences, ranging from several months to several years.
- Fines – The fines for healthcare fraud convictions can be substantial, often reaching millions of dollars, including restitution to victims.
- Professional consequences – A healthcare fraud conviction can result in the loss of professional licenses, suspension, or revocation of medical privileges.
- Reputation damage – Being accused or convicted of healthcare fraud can tarnish a medical professional’s reputation, leading to a loss of trust among patients, colleagues, and the community.
Federal and Washington State Laws Prohibit Healthcare Fraud
In Washington, healthcare fraud is illegal under the Washington Criminal Code, which includes provisions related to fraudulent insurance claims, false statements, and theft. In addition, the Insurance Fraud Protection Act covers fraudulent activities in the insurance industry.
At the federal level, healthcare fraud falls under the False Claims Act (FCA), which prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare or Medicaid. The FCA imposes substantial penalties, including civil fines and potential exclusion from participating in federal healthcare programs.
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.
Anti-Kickback Statute
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.
Some common defenses against healthcare fraud allegations include:
- Lack of intent – Demonstrating that the alleged fraud was a result of unintentional errors or misunderstandings rather than intentional deception.
- Insufficient evidence – Challenging the prosecution’s evidence and arguments to show that they have not met the burden of proof required for a conviction.
- Compliance – Arguing that you followed accepted industry practices and standards, and any deviations were unintentional or justified.
In rare cases, entrapment may also be a viable defense. This involves showing that law enforcement or government agents induced or coerced you to commit healthcare fraud.
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.
Why Choose Jennifer Horwitz Law?
The best way to defend against healthcare fraud charges is to have the informed representation Jennifer Horwitz Law provides. When you meet with Jennifer, she will explain the charges against you, and explore all your options. You can depend on her to handle your case with urgency and work to protect the medical career you’ve worked so hard to establish. Jennifer will:
- Evaluate the evidence, documents, and any relevant information related to your case to identify potential weaknesses in the prosecution’s case
- Conduct an independent investigation to gather additional evidence, interview witnesses, and uncover any information that may be crucial to your defense
- Review medical records, billing documents, and other relevant documents
- Engage qualified experts to provide testimony that supports your defense.
If your case proceeds to trial, Jennifer will provide strong and effective representation in the courtroom. She will present your case, cross-examine witnesses, and challenge the prosecution’s evidence to create reasonable doubt in the minds of the jurors.
Jennifer Horwitz is committed to winning an acquittal; however, in the event of a conviction, she will advocate for you during the sentencing phase and argue for reduced penalties or alternative sentencing options. If you are dissatisfied with the outcome, Jennifer will determine whether you have grounds for an appeal.
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.