Healthcare Fraud

Healthcare fraud is an enforcement priority for the federal government and the state of Michigan. If you are under investigation for health care fraud, the value of working with an experienced federal attorney cannot be overstated. Michigan federal healthcare fraud lawyers have in-depth knowledge of compliance issues and have successfully represented medical providers facing a federal investigation.

Examples of fraudulent activity that frequently give rise to criminal liability include, but are not limited to:

• Billing for services or items that were not rendered
• Overbilling for medical services
• Overcharging for medical procedures
• Falsifying medical records
• Upcoding (i.e. intentionally assigning an inaccurate billing code to a procedure to increase reimbursement)
• Billing for a non-covered service as a covered service
• Filing duplicate claims for the same service
• Receiving kickbacks for referrals

Healthcare fraud can be investigated by a variety of different governmental entities including the US Attorney's Office and the FBI within the DOJ. These entities also tend to work in coordination with the Office of Inspector General (OIG), which is responsible for civil enforcement of fraud and abuse of Medicaid and Medicare programs. Individuals should ontact a Michigan Federal Healthcare fraud lawyer to find out how they can help.

Healthcare fraud is the filing of false or misleading healthcare claims in an attempt to make a profit or obtain some other benefit. There are a wide-variety of health care fraud schemes, most of which involve some form Medicaid or Medicare abuse. There are a number of federal laws that are designed to combat health care fraud. Some of the criminal statutes most commonly used to prosecute health care fraud at the federal level include a healthcare fraud statute, anti-kickback statute and false statements related to health care matters. For anyone interested in defending related charges against them, a Michigan federal healthcare fraud lawyer can help.

The healthcare fraud statute is an offense to knowingly and willfully execute or attempt to execute a scheme or artifice to defraud any healthcare benefit program or obtain any money or property of a health care benefit program by false or fraudulent pretenses. A violation of this statute is punishable by up to 10 years in prison and/or up to $250,000 in fines.

The Anti-Kick Back Statute (AKS) is contained within Section 1128B(b) of the Social Security Act. The AKS makes it a felony to knowingly and willfully to offer, pay, solicit, or receive any remuneration either directly or indirectly in return for referring or inducing referral for services reimbursable by a Federal health care program. Criminal penalties include a maximum fine of $25,000 and imprisonment of up to 5 years.

Michigan federal healthcare fraud lawyers understand that false statements is a crime to knowingly and willfully falsify or conceal a material fact, make a materially false or fraudulent statement, or use any materially false or writing or document in connection with the delivery of or payment for healthcare benefits. It is punishable by a fine and/or up to 5 years of imprisonment.

In addition to the criminal penalties provided under these laws, healthcare fraud often results in civil penalties. The Federal Civil False Claims Act is the primary law used to impose civil liability on any person who knowingly submits or causes to be submitted, a false or fraudulent claim for payment to the federal government.