Health Care Fraud

The FBI reports that health care fraud costs the United States roughly $80 billion each year, and contributes to the rising health care costs and health care spending by the US government. Health care fraud is extremely serious, as every instance affects every customer due to the fact that the health care provider passes the costs along to its customers. The prevalence of health care fraud and health care schemes is growing throughout the country and statistics now show that 10 cents of every dollar spent on health care will be put towards paying for fraudulent health care claims. Efforts to combat fraud were consolidated and strengthened under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Consequently, the Federal Bureau of Investigation has dedicated a section of their office to targeting fraud through the use of task forces, strike teams, and undercover operations. In addition, Massachusetts has developed a unit devoted to investigating and combatting fraud committed by health care professionals and facilities licensed by the Board of Registration of Chiropractors and the Board of Registration of Allied Health. This unit is known as the Health Care Fraud Unit (HFCU). In the event of a conviction for heath care fraud, the offender faces serious consequences such as incarceration, fines, and the potential of losing ones medical license. If you have been investigated for or charged with a violation of health care fraud, it is essential that you contact a knowledgeable criminal defense attorney who is familiar with the complex area of health care law.

Violators of health care fraud may be federally prosecuted under 18 USC Ch. 63, Sec. 1347. The law provides that anyone who knowingly and willfully executes, or attempts to execute, a scheme or artifice to (1) defraud any health care benefit program; or (2) 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 services, shall be found in violation of the law and subject to the following penalties:

• A fine,
• Imprisonment for no more than 10 years, or
• Both fine and imprisonment.

Health care fraud is considered a white-collar crime and involves the filing of dishonest, untruthful or misleading health care claims to turn a profit. Fraudulent health care schemes come in many forms and can be carried out by both patients and practitioners. Medicare and Medicaid investigations and fraud allegations typically involve alleged billing for services never performed, receiving and paying kickbacks, paying patients and doctors to prescribe medication and medical equipment that is unnecessary. Other schemes include fraud by clinics or laboratories that order unnecessary testing without the physician's knowledge.

A conviction for health care fraud can destroy a person's professional career, disrupt a successful business or result in the loss of one's medical license. Whatever difficult dilemma you face, the Law Office of Patrick J. Murphy is here to help. Speaking with a qualified Massachusetts health care fraud defense lawyer may ease the stress and tension you feel, and also ensure that your rights are protected from beginning to end. As a dedicated criminal defense attorney, Patrick J. Murphy, Esq. has been instrumental in the vigorous defense of his clients throughout Massachusetts for over 18 years. For a free and confidential assessment of your case, please call (617) 367-0450 or email us directly using our online contact form.