Federal law and health care fraud charges

In our last post, we spoke a bit about proving fraudulent intent in criminal cases and the importance of working with an experienced criminal defense attorney to make sure that prosecutors are doing their job when it comes meeting their burden of proof. This, of course, is true not only of proving criminal intent, but with all the elements of any criminal charge. Without providing reliable evidence supporting each and every element of a criminal charge, a defendant cannot rightly be convicted.

When it comes to health care fraud, there are a handful of important federal fraud and abuse statutes that provide the basis for fraud charges. A couple of these specifically provide for criminal penalties. The False Claims Act is one of these statutes. Under the FCA, a physician can face criminal charges for submitting false health care claims he or she knows to be “false, fictitious or fraudulent.” Fines and imprisonment can result upon conviction. 

Another law that can serve as a basis for health care fraud prosecution is the Anti-Kickback Statute, which prohibits health care providers from knowingly and willingly paying money for business referrals that lead to payments from federal health care programs or accepting bribes in connection with billing for these programs.

It is common for health care fraud schemes to involve some form of bribery, but not every case of referral for health care services paid by a federal program constitutes fraud. A provider who does not meet the intent requirement cannot be targeted under the statute, and it is important for physicians facing these circumstances to work with an experienced criminal defense attorney

In our next post, we’ll continue discussing this issue.

Source: Office of Inspector General, “A Roadmap for New Physicians,” Accessed June 10, 2015. 

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