Health care in this country is primarily paid directly from private health insurance companies and public health medical assistance programs such as Medicaid and Medicare. Health care providers include doctors, nurses, home health care specialists, pharmacists, and physical therapists. They also include the vendors of durable health care goods like wheel chair, walkers and other medical supplies and equipment. When one of these professionals knowingly overbills, bills for services that were not provided they can be indicted and convicted with health care fraud. When is occurs on a repeated basis over a period of time it will be identified as a scheme and become a target by a federal law enforcement agency such as the FBI, Department of Justice, and the Department of Health and Human Services. These investigations often lead to federal criminal charges in the Federal Court in the Eastern District of Michigan.
One of the most commonly federally investigated and prosecuted health care fraud are involving Medicare fraud schemes. Medicare is federally governmentally funded health care for person over the age of 65 and those with qualifying disabilities. Medicare fraud costs the government and taxpayers literally billions of dollars and is at the centerpiece of federal health care reform legislation. In 2007 the Obama created the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to investigate and prosecute the largest Medicare fraud schemes. HEAT is a combination of efforts from the FBI, Department of Justice, Department of Health and Human Services. They have been tasked to perform comprehensive investigations in nine target cities of this country. At the top of that list is Detroit.
The healthcare providers most often investigated and prosecuted in the Eastern District of Michigan are physical therapists and home health care providers. The investigations are very thorough and everyone involved are getting indicted as a part of the conspiracy scheme. They include doctors, nurses, home health care providers, administrative assistants, therapists, and patient recruiters. Anyone who has anything to do with the schemes and with knowledge of its fraudulent nature.
Investigation techniques include advanced data analysis techniques of billing records looking for suspicious patters and increased cooperation with local governmental agencies.
Effective defenses include establishing the government cannot prove knowledge of the fraudulent intent, services were not performed or that the billing was not accurate.
Typical charges that accompany health care fraud indictments include wire fraud, obstruction with a health care criminal investigation, prescription fraud, conspiracy, anti-kickback charges and money laundering. Prosecutions are in the Federal Disitrict Court in the Eastern District of Michigan.
The government also attempts to recoup lost funds through federal civil forfeiture laws and enforcement of the federal false claims act which monetarily penalizes person fraudulently making a false claim for payment or approval from the federal government. Each claim is punishable of a fine between five and ten thousand dollars plus three times the damages the government sustains.
If you or a loved one is the target of a federal health care fraud investigation in the Metro Detroit counties of Oakland, Wayne or Macomb Michigan you must retain an attorney with federal criminal defense experience. Call attorney Barton Morris as soon as possible to take the actions necessary to receive the best defense for the best possible outcome to this complicated investigation and prosecution.