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The Basics of Healthcare Fraud

White Collar Criminal Defense By Harvey Binnall PLLC - 2018/10/17 at 09:47pm

Contact an Alexandria Healthcare Fraud Lawyer Today

If you’re a healthcare professional (or involved in the management/billing department of a healthcare organization), then chances are that you’re feeling the “squeeze” of the insurance industry on your practice.

The regulatory framework surrounding the healthcare industry in the United States has created a fundamental conflict for those attempting to provide high-quality healthcare — though effective healthcare is that which is deeply patient-focused, those involved in providing such care must be extremely cognizant of their billing practices.  Minor errors can escalate into a healthcare fraud investigation that undermines the legitimacy of your practice, interferes with your day-to-day professional life, and more.  Finally, in the event of conviction, the penalties can be severe and life-altering.

Given the high stakes nature of healthcare fraud defense, it’s critical that you seek the assistance of a team of attorneys who understand how to navigate such disputes and secure favorable results.  Contact Harvey & Binnall, PLLC to learn more about how we can help.

Healthcare Fraud May Involve a Range of Unlawful Practices

All fraud involves intentional deception or knowing misrepresentation, including healthcare fraud (which also requires that such deception/misrepresentation be effectuated for the purpose of financial gain).  In the healthcare fraud context, a wide range of unlawful practices can give rise to a healthcare fraud charge.

Examples include:

  • Billing inconsistencies — billing for a more pricy service/treatment than was actually given to the patient, billing for services that were not actually rendered, double billing, and bundling together services to make them more expensive than if they had been billed separately.
  • Conflicts of interest — receiving payments “under the table” for recommending or using certain medical products, even if the patient’s healthcare would be better served by alternative products.
  • Excessive healthcare provision — recommending treatment or other services that are clearly unnecessary will expose the healthcare provider to potential liability for healthcare fraud.
  • Prescribing high quantities of narcotic medication — prescribing an excessive amount of controlled narcotic substances to patients may be indicative of profiteering tactics.

It’s important to note that healthcare fraud requires:

  1. Intentionality or knowledge; and
  2. For the purpose of financial gain.

If you can demonstrate that your “fraudulent” conduct was in fact mere negligence, then you can avoid criminal liability altogether.  Even if you intentionally recommended excessive and unnecessary treatment, for example, you can avoid criminal liability so long as you can show that the purpose of your conduct was not to derive financial gain.

Contact an Experienced Alexandria Healthcare Fraud Lawyer for White Collar Criminal Defense Assistance

Harvey & Binnall, PLLC is a boutique white collar criminal defense and litigation firm based out of Alexandria, VA, and serving diverse clientele — individuals, businesses, and public organizations alike — located throughout the Virginia, Maryland, and the Washington D.C. metro region.

We have extensive experience representing white collar criminal defendants in a range of disputes, including those that involve allegations of healthcare fraud.  Over the years, we have substantial success navigating the complex set of regulations that define healthcare fraud and have helped clients avoid criminal liability.

Call (703) 888-1943 or request an appointment online to speak to an experienced Alexandria healthcare fraud lawyer at Harvey & Binnall, PLLC.