Philadelphia Health Care Fraud Attorney
Federal law prosecutes parties and individuals found stealing money from any federally funded health care insurance program, charging them with Medicaid and Medicare fraud. The federal statute loosely defines Medicaid and Medicare fraud, allowing the government to prosecute a wide range of actions.
The statute reads:
“Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be … imprisoned not more than 10 years. If the violation results in serious bodily injury … such person shall be … imprisoned not more than 20 years; and if the violation results in death, such person shall be …imprisoned for any term of years or for life.”
A separate section addresses the issue of cover ups. Section 1035 of the law says:
“Whoever, in any matter involving a health care benefit program, knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any materially false, fictitious, or fraudulent statements or representations, or makes or uses any materially false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 5 years, or both.”
Because of this loose definition, instances of human error and harmless oversight can be harshly charged. If you are facing medical and Medicare fraud charges, you need an attorney on your side that understands the nature of these charges and how to protect your interests.
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At Hark and Hark, we provide aggressive, knowledgeable and skilled defense to individuals who have been charged with counts of medical fraud. We are committed to advocating on your behalf to ensure that your story is told and your rights protected.
Medicaid And Medicare Fraud
Many times, these types of cases involve doctors, dentists, hospitals or clinics that claim for treatments, examinations, medical devices or procedures that either weren’t needed or weren’t provided. Offenses charged as Medicare or Medicaid fraud can vary from isolated instances to widespread conspiracy.
We will carefully examine the offense to determine where the inconsistency occurred. Often the best defense against these charges is rooted in the details. We will determine if the inaccurate billing was a result of clerical error, employee oversight or malice, missing documents or regulator error.
The issues in these Medicaid and Medicare fraud health care cases focus on the employees of any medical office that aid and abet a medical provider in the artifice or scheme to defraud.
Knowingly submitting medical bills, via electronic wire or by mail, to any insurance program through which funds are supplied by the federal government under any federally funded program by using the federally identified billing codes may warrant charges as either a coconspirator or charged with aiding and abetting the provider in carrying out the scheme.
Worse still are the obstruction charges that follow any false statement regarding the fraud. Separate collateral license suspensions or revocations for the principal of these medical officers and nursing staff are also at issue.
The federal statute allows prosecution not only of those accused of stealing money from federal programs, but also of individuals who knowingly falsify, conceal or cover up an attempt to commit fraud against these federal programs.
If convicted, the individual could be heavily fined or imprisoned. Employees of any medical office that aid or abet a medical provider in stealing money or conducting fraud are generally under additional scrutiny.
Health Care Fraud Involving Private Insurance
Knowingly submitting false or fraudulent medical bills, via electronic wire or by mail, to any insurance program is grounds for prosecution. These charges are accelerated if the funds are supplied by the federal government under any federally funded program by using the federal billing codes.
Additional obstruction charges may be added if the individual provides false information or makes false statement regarding the scheme. There may also be separate collateral license violations, revocations or suspensions for the principal of these medical officers and nursing staff.
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