Health care fraud is a serious crime that can lead to fines, a loss of your medical license, and even jail time. For this reason, building up a strong defense is crucial. As soon as you find out you’re being investigated, go through your compliance program and hire an experienced medical fraud defense lawyer. They will work with your internal team to have the evidence brought against you dismissed and to find proof of your innocence.

Ask a Medical Fraud Defense Lawyer: How Do You Defend Against a Medical Fraud Accusation?

It is estimated that $68-230 billion dollars get lost to health care fraud every year. This amounts to 3-10% of the American healthcare budget. Due to the scale of this problem, officials have started to investigate fraud cases more thoroughly.

If you’re being audited or you’ve been accused of health care fraud, it’s important to take action ASAP because the consequences of a conviction are harsh, and they could ruin your career or business.

Check Your Compliance Program

Every medical practice should have compliance policies and procedures in place. Before you take action, check your compliance program, which might give you a roadmap for dealing with this kind of situation.

This can be helpful because it takes away the decision-making element of the situation. Instead of having to scramble to make last-minute choices, you can follow the guide you’ve crafted ahead of time. As a result, you can avoid mistakes and delays.

Work with an Experienced Attorney

Trying to defend yourself against health care fraud allegations without the help of an attorney is a bad idea because these cases are often complex. If you fail to defend yourself well, your reputation could be ruined, and you could go to jail. Always hire the best lawyer you can find, and choose someone who has experience with the kind of crime you’re accused of. Medical fraud is a complex and multi-faceted field, and it incorporates various actions.

For example, you might be accused of billing Medicare or Medicaid for treatments that didn’t take place or that were unnecessary, filing the same claim several times, or prescribing unnecessary drugs covered by healthcare and then selling them on the black market. Since each of these requires a unique defense, ask your lawyer whether they’ve worked on a case like yours before.

Assemble a Team

Being investigated for fraud can take up a significant amount of your time. However, you’ll still have to run your practice and serve your patients at the same time.

To keep everything running smoothly, consider assembling an internal response team that can work with your attorney and the other people involved in the case. For best results, select someone who is not implicated in the trial and who has first-hand knowledge of your compliance practices and record keeping.

Question the Evidence

Medical fraud is hard to prove. In fact, the Department of Justice only charged 167 individuals with health care fraud in 2020. To get the defendant convicted, the plaintiff not only has to demonstrate that money was lost, but they also have to show that the defendant intended to commit the crime.

Since it’s challenging to prove that someone intended to commit a crime, questioning the plaintiff’s evidence is one of the most effective defense tactics. Your medical fraud defense lawyer in Houston, TX will argue that you made a mistake, for example, because you were feeling unwell or because you were overworked.

Provide Your Own Evidence

Often, disputing the evidence of fraud isn’t enough, and you’ll have to bring your own proof that you are innocent. The kind of evidence you need depends on your situation. If you took someone else’s funds, you might be able to prove that you were given permission. On the other hand, if you’ve been accused of fraud because you have a much higher volume of claims than other practices in your area, you might need expert witnesses from the medical field.

They can confirm that the treatments you ordered were necessary. You could also ask some of your patients to speak about the care they received and how they benefitted from it. On the other hand, businesses that were a victim of identity theft will have to prove that they did not commit the crime themselves. If you were coerced into action by a police officer or agent, you can claim that you wouldn’t have committed fraud under normal circumstances.

Medical practices that have been accused of health care fraud have to take action ASAP to protect their reputation. Check whether you already have compliance procedures in place, then hire a white-collar crime lawyer who will help you build up a strong case. Always choose someone who has worked on similar cases before, since they will be able to build a stronger case. A good lawyer will work with your team to disprove the evidence brought against you.


Categories: General

Nicolas Desjardins

Hello everyone, I am the main writer for SIND Canada. I've been writing articles for more than 12 years and I like sharing my knowledge. I'm currently writing for many websites and newspapers. I always keep myself very informed to give you the best information. All my years as a computer scientist made me become an incredible researcher. You can contact me on our forum or by email at [email protected].