Healthcare Fraud – 18 U.S.C. § 1347

The health care industry is one of the largest sectors of the U.S. economy. Because of this, health care fraud is aggressively investigated and prosecuted by the federal government.

Basics of Healthcare Fraud

Health care fraud covers numerous white collar offenses at all levels of the health care industry. It can include the following types of conduct:

  • Billing fraud
  • Falsifying medical records
  • HIPAA (Health Insurance Portability and Accountability Act) violations
  • Insurance fraud
  • Kickbacks
  • Medicare and Medicaid fraud
  • Performing unnecessary procedures
  • Unbundling
  • Upcoding

Under 18 USC § 1347, health care fraud normally carries up to 10 years in prison. Charges of health care fraud are also often accompanied by conspiracy charges. These cases can be factually and legally complicated and may require the help of an expert (such as a physician or medical billing expert) who can work with your attorney to prepare for trial or other court proceedings. It is important to obtain the help of a federal health care fraud attorney who is knowledgeable and experienced in defending against charges of health care fraud and who has experience in working with such experts.

Defenses To Health Care Fraud

Healthcare fraud cases frequently turn on whether the defendant acted with “fraudulent intent.”  Often, the key to winning healthcare fraud cases is showing that the defendant acted in good faith or made an innocent error.

For example, if you are prosecuted for over-billing an insurance company, but someone in your office made a clerical error or believed in good faith that the billing was appropriate, you may have a valid defense based on lack of fraudulent intent. Similarly, if the government alleges that a medical procedure was unnecessary, you may have a defense by presenting evidence that the procedure was objectively medically appropriate, or that you subjectively believed the procedure was medically appropriate.  Health care fraud cases can be based on a wide range of conduct, so it is imperative to obtain the advice of a skilled federal criminal defense attorney who can advise you after thoroughly reviewing the facts of your case.

Experienced Federal Healthcare Fraud Attorneys

If you are being investigated or prosecuted for health care fraud, speak to an attorney experienced in federal healthcare fraud prosecutions to learn what defenses you may have.

At Burnham & Gorokhov, PLLC, we represent clients charged with or under investigation for health care fraud, including doctors, pharmacists and staff. In some cases, we have been able to resolve health care fraud investigations without charges ever being filed.

To schedule a free phone consultation, please call our office in Washington, D.C., at 202-386-6920. You can also complete the online contact form.