Phoenix Healthcare Fraud Lawyer

• Unbundling by charging multiple codes for treatments that should be billed as a single charge to increase payment
• Pharmacy fraud (billing for medication but not actually filling the prescription)
• Prescription fraud by overprescribing opiates
• Billing for unnecessary or unreasonable services, goods (such as durable medical equipment), or costly testing

Jason Lamm provides clients with crucial guidance and defense strategies to fight healthcare fraud charges. Given the complexities of healthcare laws and regulations, it’s important to work with an attorney who understands how to mitigate penalties while protecting clients' professional and personal lives. Working with the right attorney can be a decisive factor in achieving a favorable outcome in your case. 

Arizona and Federal Healthcare Fraud Violation Penalties

Healthcare fraud is classified as a white-collar crime that involves the filing of falsified healthcare claims to make a profit. Due to the aggressive response by the U.S. government, what were once observed as simple billing errors are now regarded as fraud. Federal law provides for both criminal and civil penalties for healthcare fraud. While civil penalties only require restitution to be paid, state and federal criminal charges can lead to significant consequences.

These federal penalties include the following:

• Prison
  • Lying in regard to Medicaid or Medicare claims is punishable by five years in prison per offense.
  • Federal healthcare fraud is punishable by a 10-year prison sentence per offense.
  • Healthcare fraud causing serious bodily injury is punishable by 20 years in prison.
  • Healthcare fraud causing death carries a possible life sentence.
• Fines
  • Lying in regard to Medicaid or Medicare claims can carry a fine up to $250,000 per offense (singular offender), or up to $500,000 per offense (organization).
  • Organizations that commit ongoing fraud can face fines in the millions or even billions of dollars.

The National Rapid Response Strike Force

In 2020, the National Rapid Response Strike Force was established within the Health Care Fraud Unit to investigate and prosecute fraud cases involving major healthcare providers that operate in multiple jurisdictions, including major regional healthcare providers operating in the Strike Force cities.  The focus is on investigations and prosecutions of individuals and corporate healthcare fraud. At the heart of most federal criminal healthcare fraud investigations are claims that the Centers for Medicare & Medicaid Services (CMS) were defrauded. 

Investigations conducted by the Strike Force typically move quickly and aggressively and are handled by criminal investigators from:

• DOJ
• HHS (Health and Human Services)
• FBI (Federal Bureau of Investigations)

The government's proactive stance and resource allocation underscore the seriousness with which healthcare fraud is addressed. Through rigorous enforcement and collaboration across multiple agencies, the HCF Unit uses the resources of the federal government to pursue these cases aggressively.

Federal Healthcare Fraud Investigations and Asset Seizure

The Washington D.C.-based strike force not only criminally investigates subjects or targets of illegal activity but also utilizes civil attorneys who routinely seize and forfeit assets suspected of being the proceeds of improper activity. Waiting to hire a criminal healthcare fraud attorney can be devastating as the government can seize your assets and leave you financially powerless to hire an experienced white-collar criminal defense attorney like Jason Lamm. 

If an investigation progresses to the point that federal prosecutors believe that they have probable cause to take a case before a federal grand jury, the most common charges filed include:

• Conspiracy (18 U.S.C. § 371)
• Wire Fraud (18 U.S.C. § 1343)
• Healthcare Fraud (18 U.S.C. § 1347)
• Healthcare Fraud Conspiracy (18 U.S.C. § 1349)
• Money Laundering (18 U.S.C. § 1956)
• Anti-Kickback Violations (42 U.S.C. § 1320a-7b)

Early legal representation is crucial in navigating the complexities of federal healthcare fraud investigations and can significantly impact the outcome of the case. By securing a seasoned attorney promptly, individuals and entities can better safeguard their rights and assets while developing a robust defense strategy.

Impact on Licenses

In certain jurisdictions, facing charges under federal healthcare fraud statutes can lead to the administrative suspension of licenses for healthcare professionals such as physicians, nurses, and nurse practitioners. Being proactive is crucial, as state licensing boards can impose interim sanctions that limit a professional's ability to practice, even under the Constitutional presumption of innocence. Unlike federal criminal courts, which operate on the presumption of innocence, administrative boards may act on a presumption of guilt, making early intervention essential to protect one's professional license and career.