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Virginia Federal Health Care Fraud Attorney

Health care fraud is a crime in which someone files a health care claim in an attempt to make a profit or to gain some type of benefit. If charged as a Virginia (state) crime, it is usually viewed as a white collar felony theft. But most cases of health care fraud are classified as federal felonies arising from Medicare and Medicaid abuse – the most common forms of health care fraud. Providers, patients, and even health insurers are capable of committing this crime. It can be charged as either health care fraud or insurance fraud (if the later is committed against a private carrier.

And since most corporate health care providers have high-priced law firms to protect them from such charges, this information is offered to individual health care providers (e.g. doctors, medical practitioners) and individual claimants who are facing charges of – or being investigated for – health care or insurance fraud for filing false claims. There are a variety of charges you may face in which a dedicated Virginia federal health care fraud lawyer would be needed. These charges may include, but are not limited to:

  • Medical billing errors
  • Charging for services not performed
  • Overbilling for medical services
  • Inflating medical procedure costs
  • Falsifying patient records
  • Performing (or acknowledging) unnecessary procedures

Has Fraud been Committed, or is it Just a Mistake?

In any business-related fraud charge, it’s important to distinguish the evidentiary difference between – in this case – outright health care fraud (illegally receiving improper payments or conspiring to receive improper payments) and an honest mistake, omission, or billing error. In order to commit fraud, a person must knowingly – and willingly – “engage in a plan, scheme, or activity to provide falsehoods, with the intent to achieve financial gain.” You can read the full text of the federal statute here.

Only a qualified federal health care fraud lawyer, however, can give you a full and accurate explanation of how the law works, recent decisions, and how it may apply to your case.

For example, it is not a fraud if a doctor’s bookkeeper makes a billing mistake that results in a patient being billed for treatment he or she did not receive. On the other hand, if a health care provider knowingly provides treatments or procedures that the provider knows patients do not need, and then bills an insurer for those procedures with the intent of making an illegal profit, this is health care fraud.

If more than one provider works in concert with another to defraud, or if a health care provider and patient work together to that same end, it may be indicted as a conspiracy to commit health care, or insurance fraud if a private insurer is the victim of the fraud.

Common fraud schemes committed by patients can include:

  • Faking an illness or medical condition with the intent of receiving medications that the patient then sells;
  • Falsifying medical claim information, or using someone else’s insurance information to receive health care services.

Penalties for Health Care Fraud are Serious

Federal health care fraud penalties can be civil and criminal and can include fines, prison, and an order to pay restitution. An experienced and skilled Virginia federal health care fraud lawyer can help defend you against these various legal penalties.

Civil penalties – which are commonly pursued by private insurance carriers in state courts – do not involve criminal penalties, often result in an order to pay fines and restitution, and may bring punitive damages over-and-above actual damages. Criminal health care fraud charges, both at the state and federal level, can lead to serious long-term consequences for anyone convicted.

  • Prison – Making a false claim or false statement in relation to a Medicaid or Medicare claim can lead to a 10-year federal prison sentence per offense. If the federal health care fraud results in serious bodily injury or death, a potential sentence of 10 to 20 years in prison is possible. Virginia law can call for prosecution of grand larceny with sentences of one to 20 years in prison.
  • Fines – Individuals who make false Medicare or Medicaid statements are subject to fines of up to $250,000 per federal offense. Organizations that make false claims face up to $500,000 per offense. Organizations that conspire to make false claims face multiple counts of health care fraud and millions – even billions – in fines. Virginia grand larceny fines against individual offenders can result in $2,500 fines for each offense.
  • Restitution – In state or federal courts, the judge can order defendants to pay back all monies improperly obtained as a result of health care or insurance fraud. For example, a doctor who improperly billed an insurance company for tests not performed will typically be ordered to repay the money owed to the insurance company, or Medicare/Medicaid.
  • Probation – Anyone convicted of health care fraud crime may also face probation or, some cases, a reduced sentence and then parole. Both release programs severely limit your freedoms. Probationary terms can last several months to several years. Parole usually begins after serving at least one-third of the sentence. Those on probation or parole must comply with specific conditions such as regularly meeting with a probation/parole officer, maintaining employment, not associating with known felons, and avoiding criminal behavior. Failure to honor any condition is cause for revocation of parole or probation, and can result in incarceration.

Aggressive Federal Criminal Lawyers Make a Difference

Charges of health care or related insurance fraud can be just as devastating as a conviction. It can affect how friends, family, and employers view you and tarnish your professional and personal reputation. Those convicted of health care or health insurance fraud who are not American citizens face the additional threat of deportation and denial of residency or citizenship.

If any of these scenarios apply to you, contact our law office today to discuss the specifics of your case and to find out your best options for protecting your rights. Retaining experienced legal counsel is imperative if one is charged with a federal criminal offense, and it is in a person’s interest to do so as soon as possible.