Health Care Fraud Defense Lawyers| Health Care Law

It is safe to say that once it comes to Health Care Fraud Defense Lawyers we are actually in safe hands; Health care fraud is said to be committed when a provider or patient intentionally submits or causes someone else to submit misleading or falsified information that results in an improper amount of payable health care benefits.


Healthcare fraud is a serious crime and can be committed by both medical providers and their consumers or patients. A healthcare fraud investigation can get complicated very quickly. Should you find yourself involved in a healthcare fraud investigation, you will not want to have to navigate the legal aspects on your own.

A healthcare fraud attorney with a reputation for success will help you walk through the entire legal process to work toward a positive outcome. A healthcare fraud attorney knows the legal process backward and forward, and their insight into how the government investigates and prosecutes will be used to your advantage.

Understanding Health Care Fraud

Healthcare fraud can involve the improper handling of claims that are billed by the medical provider or filed by the consumer. Dishonest submission of these claims can lead to healthcare fraud.

Healthcare fraud investigations usually involve allegations of defrauding private insurance companies, Medicare, Medicaid, workers’ compensation, or Tricare. These cases often involve multiple parties such as executives, hospital workers, marketers, medical professionals, labs, rehabilitation or nursing facilities.

Every year, billions of dollars are lost in healthcare fraud. If you are indicted or convicted of such crimes, you can face harsh sentences that will affect your life forever.

Health Care Fraud Punishments

Healthcare fraud convictions can bring about substantial penalties, such as a lengthy prison sentence. False statements on a Medicaid or Medicare claim can result in up to a 5-year prison sentence per offense. Federal healthcare fraud can result in a 10-year sentence per offense.

If the fraud leads to bodily harm, it could potentially mean up to a 20-year sentence in prison. In addition, you could also face a fine of anywhere from $250,000 to $500,000 depending upon the claim. Organizations could face millions or even billions of dollars in fines.

A judge may also order that defendants must pay restitution, meaning the defendant must pay back a set amount of money that was lost as a result of health care fraud. For instance, a doctor who improperly billed an insurance company for tests that weren’t performed may be ordered to pay back this money to the insurance company.

Restitution is in addition to any fines issued. A defendant convicted of health care fraud can also face probation, which limits the freedoms a person has instead of jail time. This could last from 12 months to three years.

Health Care Fraud Misconduct

Healthcare fraud can be very broad, but several different things can fall under the umbrella of healthcare fraud misconduct, such as the following:

  • Billing for services considered not medically necessary
  • Billing for services never provided
  • Upcoding claims – submitting claims that are higher than the level of service provided for higher reimbursement
  • Unlicensed services
  • Submitting duplicate claims
  • Misrepresenting diagnosis or procedure to capitalize on maximum payments
  • Unbundling procedures – serrating costs for procedures normally billed as one kind of treatment
  • Altering medical records or reports
  • Receiving kickbacks for any goods or services

If you have been accused of one or more of these misconducts, you could be facing serious consequences. You don’t have to face it alone. Our team knows what to do in every circumstance and will walk with you throughout the entire legal process, from investigations to trial.

Health Care Fraud Defense Lawyer Services

Healthcare fraud investigations or criminal cases do not tend to move quickly or end in a short time. They are intricate, well-researched investigations that are led by intelligent, knowledgeable prosecutors aiming to convict, meaning they can take time.

Most of these investigations are handled by the U.S. Attorney’s office and a healthcare fraud coordinator who is in charge of handling criminal or civil cases. In addition, Washington D.C. is the headquarters for the Health Care Fraud Strike Force whose job is to determine the cities with the highest health care fraud to further investigate health care within those cities.

It’s clear that on a local and national level, healthcare fraud is being taken very seriously. Because these are teams of specialized prosecutors, they can be a formidable opponent. Top-level government agencies can get involved, such as the FBI, MFCU (Medicaid Fraud Control Unit), US DEA (Drug Enforcement Administration), or the US Department of Health and Human Services.

They have countless resources available and can effectively build a strong case. Being accused of healthcare fraud means that you need someone on your side. It requires the services of a highly capable, professional, and skilled healthcare fraud attorney to protect you and your assets.

Duties of a Health Care Fraud Defense Lawyer

A healthcare fraud Lawyer will begin an investigation into your case by examining data, speaking to any witnesses, and seeking the advice of experts to give testimony on your behalf. They will also work hard to cast doubt on your intention to participate in a crime or reduce company exposure during this investigation.

Rest assured, the team of healthcare fraud lawyers is well prepared to defend against what may be coming your way, such as audits, investigations, inquiries from MFCU teams, grand jury proceedings, Controlled Substances Act diversion investigations, FCA investigations, or any other fraud charge or kickback charge that has been brought forward.


There is no healthcare fraud investigation too big or too small for an experienced lawyer. Once you suspect or get involved in a Health Care Fraud kindly contact a skilled health care fraud lawyer for help. And with the above information, I believe you now have a clear understanding of why you might require the service of a Health Care Fraud Lawyer if need be.

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