Medical care fraud in the United States is estimated at $80 billion a year according to the
Federal Bureau of Investigation. Insurance fraud charges have become the focus of
attention of federal, state and local law enforcement agencies and prosecutors. With
so much money at stake, prosecutors regard defrauding the health care system as a
serious white-collar criminal violation, and they aggressively prosecute
those suspected of committing it.
State and federal laws and regulations governing the delivery of health care services and
the billing practices of providers are complex and prone to ambiguities in their
application. If you are under investigation by one or more law enforcement
agencies, you should speak to a Houston medication fraud attorney before
responding to requests for information from investigative agencies.
A case frequently begins when one or more of the following activities of an individual or group practice come to the attention of investigators:
Rand Mintzer, Attorney at Law knows that prosecutions usually focus on certain categories of conduct.
Medicaid and Medicare regulations governing billing practices and procedures can be
complicated and confusing even to trained investigators and prosecutors. Most
prosecutions for health care fraud frequently rely upon patient records, billing
statements and other documents generated by the medical provider or the
third-party insurance company handling the claim to prove wrongdoing
on the part of the health care professional.
Every document that supports the criminal case against a medical provider must be
examined to determine if the documentation supports the charges that have been
filed. Defense attorneys know that a gap in the documentation can be enough
to lead to a dismissal or reduction of the charges due to insufficient evidence
of criminal activity.
Many of the prosecutions brought against doctors, hospitals and other medical providers
are for violations of established federal laws. Federal sentencing guidelines place an
accused person at risk of a prison sentence or probation if found guilty. Judges
routinely impose substantial fines as part of the sentence and require
the convicted party to pay restitution.
Insurance fraud lawyers know that the complexities and ambiguities of some of the laws can
work in favor of a person accused of violating them. For example, safe-harbor provisions
added to the Medicare and Medicaid statutes protect individuals from criminal charges
unless prosecutors prove that payments were willfully made or received.