What Happens if I Am Found Guilty of Healthcare Fraud?

Those convicted of healthcare fraud crimes can face a myriad of consequences, ranging from criminal penalties to collateral damages. Even organizations or individuals that have only been charged – not convicted – for healthcare fraud crimes can be threatened by a blow to their reputation. Unfortunately, in some cases the entire practice can go under as a result. Common consequences of convictions for healthcare fraud include:

• Substantial fines. Depending on the value and illegal gain associated with a fraud scheme, the fines for healthcare fraud can be severe.
• Based on the extent of a healthcare fraud crime, organizations or individuals found guilty may need to pay restitution to individuals who suffered financially because of this scheme, including insurance companies, government healthcare programs, and individual patients.
• People found guilty of participating in a healthcare fraud scheme can face serious prison time. If the fraud results in serious bodily injury or a risk of serious injury to a patient, it can greatly enhance sentencing.
• Rejection from Medicare and Medicaid programs. Organizations and individuals found guilty of healthcare fraud may no longer be able to operate in tandem with government healthcare programs, losing key revenue streams that may be a lifeline to their business.
• Loss of license. Medical professionals who are found guilty of healthcare fraud may lose their license to practice in the state. State boards and other authorities in charge of licensing decide whether a medical professional should lose their license. Not every conviction leads to an automatic loss of the doctor’s medical license, however, having professional representation in both the criminal investigation and medical licensing board proceedings can significantly reduce the long-term risk to the person’s career.

Individuals or organizations found guilty of healthcare fraud can have their reputations ruined overnight. If you are facing accusations of healthcare fraud, an experienced healthcare fraud defense lawyer from our firm is here to help you fight back against the charges and defend the integrity and reputation of your healthcare organization.

Healthcare Fraud Defense Strategies

Depending on the details of your case, numerous defense strategies against healthcare fraud charges can be employed to protect your rights and the interests of you and your organization. A dedicated and experienced defense attorney from our firm can employ the following strategies:

• Proving lack of intent. Individuals can fight against healthcare fraud charges by showing that errors in billing or irregularities in financial records were not committed on purpose. Lack of intent is an effective defense strategy as such crimes involve proving a deliberate scheme to defraud.
• Questioning evidence accuracy. Evidence brought forward by the prosecution, such as patient records, billing documentation, and other files, can be scrutinized. These files are often lengthy and complex. An experienced lawyer can argue on your behalf that the evidence brought forward is not accurate, not reflective of a crime, or from a false source.
• Arguing the act was in good faith. The defense can argue that the accused believed they were acting in accordance with the law based on professional advice or information they heard or read.
• If the accused can show they committed the act of fraud because their family’s safety or well-being was under threat or under threat of losing their job, this can serve as a possible defense.
• Mistake of fact. Claiming a mistake of fact can be effective if the defendant believed they were acting lawfully based on incorrect information or misunderstanding of the facts.
• Violations of constitutional rights. If evidence was illegally obtained through the search and seizure process, or if an individual was coerced into making statements to incriminate themselves, the evidence collected unlawfully can be suppressed.
• Accepted practices. Expert witness testimony from professionals who are highly experienced in the field related to the crime can come forward to explain typical processes in the business area. They can justify the actions of the accused, working to prove that the individual was behaving in compliance.
• Questioning the prosecution’s evidence. An experienced attorney can thoroughly examine the evidence brought forward by the prosecution, calling into question whether it is reliable or valid. Furthermore, they may be able to argue that the evidence available is not sufficient to justify that the crime was committed.
• Negotiating a plea bargain. In some cases, it may be optimal to negotiate a plea bargain with the prosecution to reduce charges or minimize sentencing.

It’s important to note that healthcare fraud charges must be brought against a defendant within a specific time period, known as the statute of limitations. If the prosecution fails to press charges before this date, the case can be dropped. An experienced attorney from SBBL Law can help you determine which defense strategies may be optimal for your healthcare fraud case.