Tue May 8thDOJ Intensifies Focus on Healthcare Fraud
Experienced Alexandria Fraud Attorney Representing Those Accused of Fraudulent White Collar Crimes
Harvey & Binnall is an established white collar criminal defense law firm. Every Alexandria fraud attorney at our firm is a strong litigator. We all practice in the intense courts of northern Virginia, including the U.S. District Court for the Eastern District of Virginia “Rocket Docket” as well as other courts through the country. Our meticulous preparation allows us to think quickly and act decisively to protect our clients’ rights during all stages of a criminal investigation and trial.
Types of Fraud Allegations
Fraud is intentional deception or misrepresentation, usually for the purpose of financial gain. Fraud encompasses many different crimes, including:
- Identity Fraud
- Mail and Wire Fraud
- Tax Fraud
- Securities Fraud
- Health Care Fraud
- Medicare Fraud
- Mortgage Fraud
- Bank Fraud
- Passport and Visa Fraud
- Credit Card Fraud
- Foreign Corrupt Practices Act (FCPA)
Identity fraud involves adopting another person’s identity, typically for financial gain. Identity fraud may include passing a bad check, using an unauthorized credit card or applying for Social Security benefits that belong to another person.
What is Identity Theft?
Identity theft occurs when a person adopts another person’s name, likeness, tax ID number or other credentials, usually for financial gain. Identity fraud may be a one-time act of using another person’s credit card without authorization or forging and cashing a check. Often, identity fraud involves a broader scheme in which one individual takes over all identifying features of another, for example to commit Social Security fraud or tax evasion. Other types of identity theft include housing fraud, Internet fraud, medical fraud and consumer fraud.
Conspiracy to Commit Identity Theft
The government is aggressive about investigating identity theft that is part of a larger conspiracy. In this case, a defendant may be held liable for criminal acts of the other members of the conspiracy that contributed to the wider scheme. A defendant may be charged with both conspiracy and identity theft, and thereby increase the charges and penalties. Law enforcement often uses the conspiracy charge to transform a minor charge into a major crime and place pressure on those at the mid and bottom tiers of a conspiracy to fold.
Attorney Representation at the Investigation Stage
As with all white collar crimes, our attorneys recommend anybody who is the target of an identity theft investigation retain legal counsel. We have often been asked, “Won’t hiring an attorney make me look guilty?” The answer is no. The objective, candid advice of a Virginia lawyer is vital during the intense experience of a law enforcement investigation. Law enforcement has no duty to advise suspects of their rights during an investigation and most people do not know the relevant law.
Our experienced attorneys protect our clients’ rights during an investigation. Often, we can show that the government has insufficient evidence before charges are filed or we can negotiate cooperation in exchange for dropped charges. Early intervention is, therefore, crucial to avoid prosecution and best chance of beating charges that are filed.
However, our firm has also been retained as late as trial preparation. We jump into action to challenge the prosecution’s evidence and to minimize potential penalties to our client. Our overriding goal is to put our client in the best position possible under the facts of the case, whether aggressively fighting the government’s charges at trial or negotiating the most equitable plea deal possible.
- Mail Fraud: Mail fraud is a fraudulent transaction that occurs through the U.S. mail or otherwise uses the mail service in the commission of the crime. Mail fraud crimes have largely been replaced by Internet schemes.
- Wire Fraud: Often involving offshore accounts, a victim of wire fraud never receives the benefit or goods in exchange for the transferred money. In one type of scheme, a person pretending to be a relative, friend or stranger in need convinces the victim to wire money.
Federal law has criminalized the use of certain forms of communication in carrying out fraudulent activity, including use of the U.S. Postal Service and certain forms of online and electronic communication, referred as “wire communication.” Allegations of mail and wire fraud may be brought alone, but often are coupled with additional charges.
Mail and wire fraud cases may be linked to alleged complex financial fraud schemes and can involve serious legal consequences, including the possibility of significant fines or imprisonment. The experienced attorneys at Harvey & Binnall will vigorously represent clients accused of these offenses.
Tax fraud involves the intentional and willful actions by a U.S. taxpayer through deceit to avoid or attempt to avoid the payment of lawfully assessed taxes owed to the federal government. More than failing to pay taxes, tax fraud involves purposeful misrepresentation of income, expenses, deductions or identity to avoid taxes. A tax return that is found to be in error may be audited for up to three years past the filing date or April 15th, whichever is later. In some cases, this window can extend for up to six years where there is a larger error discovered.
Securities are highly regulated to protect investors and consumers from fraud. Securities fraud occurs when a broker, investor, bank or company makes a material misrepresentation, breaches a fiduciary duty, engages in insider trading or takes another action that risks investment or skews the market for personal financial gain. For example, a fraud investigation may involve:
- Insider trading. Occurs when a person with inside information uses that information to gain an advantage in the stock market.
- Ponzi scheme. A pyramid arrangement in which the money invested by newer investors is used to pay earlier investors.
- Embezzlement. When someone steals funds or property that they have lawful access to, such as when a broker siphons money out of the account for the personal benefit of the broker.
- Junk bonds. May be inappropriate for low-risk investors, such as elderly clients or pension funds, because of the high risk of loss involved.
- Advanced fees. May actually be illegal demands for payments that are never applied to an investment as promised.
- Pump and dump. Involves taking actions that inflate the price of a stock then selling them on the market for a windfall at the cost of the stock value.
- Accounting fraud. May produce books that reflect a company’s stability, positive growth and high profits while the company is actually failing.
- SEC compliance violations. May give rise to an investigation and criminal or civil charges.
Over the past half-century, numerous investment schemes have cost investors billions of dollars. In addition, the largest schemes have harmed the economy. As a result, the government has become aggressive about attacking companies and brokers that make mistakes, even when there was no criminal intent.
Why Hire a Federal Court Lawyer Early in an Investigation?
The SEC, FBI and other agencies may swoop in on a tip or a fishing expedition that falls far below the level needed to bring charges and prosecute. Often, white collar crime suspects have never been in trouble and believe that cooperation is the best means of deflecting suspicion. Law enforcement officers often take advantage of an individual’s ignorance of the law to coerce and misconstrue innocent statements into admissions of guilt. They try these same tactics in obtaining incriminating documents.
We recommend witnesses, subjects, and targets of an investigation retain legal counsel immediately. Our Alexandria fraud attorneys practice nationwide and sometimes can prevent charges from being filed. If charges are filed, early intervention can prevent release of damaging documents and statements that could affect the case.
Health care costs have skyrocketed in the United States, including medical care and insurance rates. Furthermore, the insurance industry remains unsettled as lawmakers propose wildly differing legislation about how to curb the costs and insure patients. Amidst this volatile atmosphere, law enforcement has focused its efforts on the conduct of medical professionals and companies. In July 2017, the U.S. Department of Justice charged 412 people, including 50 doctors, in 20 states with health care fraud amounting to $1.3 billion.
The prospect of getting caught in this web is frightening. An error can lead to expensive, time-consuming and stressful investigation of patients’ records and a practice’s accounting books. Charges can tarnish a practice’s reputation and ruin a doctor’s career. Harvey & Binnall defends practices and doctors who are targeted by law enforcement. If retained during the early stages of an investigation, an Alexandria health care fraud attorney can often help clients avoid charges and prevent disclosure of confidential or incriminating information. We also defend doctors whose licenses are at risk.
What is Health Care Fraud?
Health care fraud describes a number of crimes involving unlawful practices for the purposes of financial gain. Common health care fraud charges involve:
- Upcoding. Doctors use an insurance billing code for a more expensive service or medical device than they provided to the patient.
- Double billing. Doctors charge for an item or service twice, sometimes billing both the insurance company and the patient for the same service or medical product.
- Billing for services or goods not provided. Doctors bill the insurance company for services they did not render or goods the patient did not purchase.
- Unbundling. Certain medical procedures bundle services together that are more expensive if charged individually.
- Receiving kickbacks. A doctor may receive money or gifts from a pharmaceutical or medical device company for using or recommending its products.
- Recommending unnecessary services. A doctor may be held liable for rending unnecessary services to a patient to make more money.
- Running a pill mill. Law enforcement has targeted clinics that prescribe high levels of narcotics, often ensnaring innocent pain clinics that provide quality care to sick and injured patients.
What Should a Doctor or Clinic Do if Suspected of Health Care Fraud?
Law enforcement does not generally have a right to documents without a warrant or subpoena. Even if armed with a warrant, doctor-patient privilege may prevent disclosure of sensitive information. In addition, agents cannot compel a suspect to give a statement that may be incriminating. We recommend that doctors and clinics contact our experienced white-collar criminal defense attorney before making any statement or turning over any document to state or federal police or prosecutors.
The federal government claims that improper Medicare payments cost taxpayers billions of dollars. For this reason, law enforcement targets medical professionals and organizations in Medicare fraud investigations heavily, often ensnaring innocent parties who made a simple error. In the meantime, an investigation can disrupt a busy practice and may damage the reputation of the professionals who dedicate their lives to healing patients. Overzealous prosecution of health care fraud cases may jeopardize a doctor’s medical license or result in a long jail sentence.
Harvey & Binnall fights for doctors and clinics that face criminal investigation and prosecution. We fight disclosure of sensitive, confidential patient information and release of damaging evidence. It is often possible to even prevent charges from being filed. Our Medicare fraud lawyers are also available to defend doctors before the Virginia Board of Medicine when the investigation leads to disciplinary review.
What is Medicare Fraud?
Medicare is the government health insurance program that pays for medical care for seniors and people with disabilities. The Centers for Medicare and Medicaid Services (CMS), which runs the program, is an enormous bureaucracy that relies on a cumbersome coding, billing and payment system. Mistakes can sometimes be interpreted as fraud, including:
- Upcoding. Entering a code for a more expensive service or product
- Double billing. Billing CMS twice for the same service or product
- Billing for services or products not rendered. Billing for a service or product the patient did not receive
- Unbundling services. Charging for each service or product individually rather than in a bundle as required by Medicare regulations
- Receiving kickbacks. Receiving a gift or cash for prescribing a certain drug or device to patients
- Delivering unnecessary treatment. Often considered under a subjective standard as to what services can improve a patient’s health
- Prescribing painkillers. Often subjecting legitimate pain clinics to the high scrutiny of a pill mill
The Law Governing Medicare Fraud
Medicare fraud is an umbrella term that describes violations of various statutes. For example, a doctor or medical facility may be charged with Medicare fraud under:
- Medicare-Medicaid Anti-Fraud and Abuse Amendments
- Social Security Act (SSA)
- U.S. Criminal Code
- False Claims Act (FCA)
- Anti-Kickback Statute (AKS)
- Physician Self-Referral Law (Stark Law)
We are aggressive trial lawyers based in Alexandria, Virginia, but practice nationwide, who do not back down from law enforcement and prosecutors. We ensure FBI agents are following the law during a Medicare fraud investigation and we hold prosecutors to their heavy burden of proving accusations beyond a reasonable doubt.
Under political pressure from Congress since the financial crisis in 2008, the FBI has dedicated immense resources to investigate mortgage fraud. This typically occurs within three categories: fraud for housing, fraud for profit, or fraud for criminal enterprise. The most common mortgage fraud is lending money at subprime rates despite the high risk of default. The mortgages are then packaged for sale in the securities market. If you are facing federal charges on mortgage fraud or similarly related schemes, contacting a mortgage fraud lawyer is the first step. The attorneys at Harvey & Binnall are committed to assist you as you navigate the potentially challenging road ahead and will use all resources available to protect your rights.
Banking is a highly regulated industry that receives substantial scrutiny from law enforcement. The FBI or the bank itself may flag any unusual transactions and thus trigger an investigation. At Harvey & Binnall, we take decisive, immediate action to protect the rights of the target of such an investigation. Sometimes, it is even possible to keep the prosecution from moving forward. If prosecutors file charges, we are aggressive trial advocates who never back down from doing what is best for our clients.
What is Bank Fraud?
Bank fraud describes a class of crimes that run the spectrum in regards to seriousness and penalties. Bank fraud may include a number of individual crimes involving:
- Check forgery. Forgery involves signing and cashing a check belonging to another person. A charge of identity theft may accompany a forgery charge.
- Bouncing checks. Having insufficient funds to cover a check is not illegal. The act must be intentional to be fraudulent.
- Accounting fraud. The government must show that the accounting irregularity was intended to perpetrate fraud on a financial institution, such as demonstrating profitability of a company that is actually on the verge of bankruptcy in order to obtain a loan.
- Wire transfer fraud. Wire transfer is an efficient means of making payments. However, funds transferred to an offshore account may be less reliable and sometimes fraudulent.
- Mortgage fraud. The mortgage crisis resulted in an economic recession and has led to greater scrutiny of mortgages, some of which may be risky or ill-advised, but not fraudulent.
Defenses to Bank Fraud
Money flows freely and quickly through financial institutions, making them targets for fraud. However, law enforcement sometimes incorrectly classifies mistakes and bad deals as fraud. Substantial losses and risky transactions do not constitute fraud without the requisite intent. The prosecution must prove beyond a reasonable doubt that the act was intentional. Our fraud attorneys in Alexandria have a nationwide practice and pride themselves on holding prosecutors to this high burden of proving the element of intent in addition to all other elements.
Law enforcement often focuses on low to mid-level employees rather than the perpetrator of a scheme, thereby holding a minor player accountable for the substantial wrongdoing of a high-level boss or executive. Many high-profile prosecutions have been of people who were just taking orders from supervisors, sometimes as a condition of keeping their jobs. Some employees may even have blown the whistle on fraud within a brokerage house or company only to be reprimanded. We advocate for the rights of employees who have been made scapegoats in companywide fraudulent schemes.
Changes to immigration and travel policies have a potential to impact many individuals, who in an attempt to come to the United States, become targeted by FBI investigations. With the increasingly strict regulations in regards to the issuance and use of U.S. passports and visas, many individuals are at an increased risk for accusations of passport and visa fraud. This type of fraud can take many forms including false birth certificate use, using a stolen or altered passport, or using someone else’s identity to get a passport. Penalties range from fines to 25 years of jail time for felony-level violations such as issuing a passport without legal authority. Attorneys at Harvey & Binnall are dedicated to defending those who find themselves caught up in passport of visa fraud charges.
With the increase in technology and e-commerce, charges of credit card fraud have become more numerous. While credit card fraud is often a federal charge, it can sometimes arise under state law. Given the potential penalties for such charges, it is important to have an attorney who has experience with white-collar crime defenses by your side from the moment the charges are brought. The knowledgeable attorneys at Harvey & Binnall will help protect your rights and ensure that the best resources will be put to your defense.
The Foreign Corrupt Practices Act (FCPA) prohibits payments of bribes to foreign government officials in exchange for obtaining or retaining business. FCPA violations fall under the authority of the Department of Justice (DOJ) and the Securities and Exchange Commission (SEC). The government can impose heavy civil and criminal sanctions on individuals and business that violate the statute.
Harvey & Binnall, PLLC can represent businesses and individuals accused of FCPA violations and those called as witnesses in an investigation. It is important to recognize that counsel for a business usually does not represent the interests of individuals, even those acting in an official business capacity when the FCPA issue arose. We therefore, recommend that each person and entity, including all witnesses, subjects and targets, retain independent counsel when a government or internal investigation is imminent. We are available to represent individuals upon referral from other law firms when conflicts of interests would otherwise arise.
Defending Against an FCPA Claim
Prosecutors must prove that the individual or business attempted to bribe or corruptly influence a foreign government official to benefit an existing or contemplated business. The government must also prove that the individual or entity accused of an FCPA violation has a connection with the United States. However, the courts have applied conflicting standards for how strong that connection needs to be, and that standard remains unresolved. Although the typical case involves an American company or individual bribing a foreign official, the government has also prosecuted American businesses that bribe other businesses or individuals who work for foreign governments and bribe foreign businesses.
Careless bookkeeping may also give rise to an FCPA claim. Under the Act, businesses must maintain accurate records and implement internal rules to account for assets and transactions. The records requirements make the defense of ignorance a difficult argument for businesses claiming an employee or agent was a rogue actor.
A DOJ or SEC investigation may ensnare witnesses that are not suspected of wrongdoing and subjects and targets that the government believes may have violated the FCPA. For this reason, our firm urges all individuals to hire independent FCPA defense counsel.
The Yates Memo
Former Deputy Attorney General Sally Yates issued an important 2015 memorandum that addressed individual accountability for corporate wrongdoing. Under the guidance of the Yates Memo, the DOJ has vigorously prosecuted individuals suspected of misconduct. As a result of heightened individual prosecutions, companies have an incentive to report personnel suspected of FCPA violations. The Yates Memo did not create new law, but emphasized enforcement over individuals in addition to the companies they work for.
The False Claims Act (FCA) holds individuals and institutions liable for fraud against the government. This broad statute may apply to practically every institution that conducts business with or receives money from the government, including doctors and hospitals that accept Medicaid or Medicare insurance, government-funded institutions and all businesses that hold government contracts. Justice Department lawyers zealously pursue these politically appealing fraud claims and have an incentive to conduct high-profile investigations. Individuals and companies found liable of violating the FCA heavy fines and damages liability. Moreover, it is possible that criminal liability can follow an FCA investigation. Even news of an investigation could harm a professional’s reputation and career or damage a business’s brand and goodwill.
Harvey & Binnall, PLLC represents individuals and businesses accused of FCA violations. Our lawyers understand what is at stake in an FCA investigation and aggressively pursue the best possible solutions. Our firm recommends retaining FCA defense counsel immediately. We are often able to avoid legal actions if we are involved in the initial stages of an investigation. Should the government move forward, our early involvement is often critical to successful litigation.
Qui Tam Whistleblower Provision
The FCA contains a provision to incentivize whistleblowers to come forward. In a qui tam claim, the whistleblower sues on behalf of the government and receives a percentage of the damages recovered from the defendant. However, a person who cooperates only after the government approaches is not generally entitled to qui tam, nor is a person who the government believes contributed to the wrongdoing. Because of the potential for recovering substantial money, employees are enticed to bring qui tam claims, which are not always well developed or accurate. Unfortunately, executives, agents and officers of the company may be subjected to an investigation regardless.
Accused of a Fraudulent Crime? Contact an Alexandria Fraud Attorney Today for Assistance
Early representation is crucial if you are accused of fraud. Harvey & Binnall is available to defend your rights immediately. Schedule an appointment with us to discuss your case with an experienced fraud attorney.