Health Care Fraud Lawyers in Michigan
Fighting for Clients across Royal Oak & Surrounding Areas
Healthcare in this country is primarily paid directly by 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 wheelchairs, walkers, and other medical supplies and equipment. When one of these professionals knowingly overbills or bills for services that were not provided, they can be indicted and convicted of health care fraud. When it occurs on a repeated basis over a period of time, it will be identified as a scheme and become a target of 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 investigated and prosecuted types of health care fraud involves Medicare fraud schemes. Medicare is governmentally funded health care for any 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 administration 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, and Department of Health and Human Services. They have been tasked with undertaking comprehensive investigations in nine target cities of this country. At the top of that list is Detroit.
The health care 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 is getting indicted as a part of the conspiracy scheme. They may include doctors, nurses, home health care providers, administrative assistants, therapists, and patient recruiters. Anyone who has anything to do with the schemes and has knowledge of its fraudulent nature may be held accountable.
Investigation techniques include advanced data analysis techniques of billing records, looking for suspicious patterns 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 of a health care criminal investigation, prescription fraud, conspiracy, anti-kickback charges, and money laundering. Prosecutions are in the Federal District 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 individuals fraudulently making a false claim for payment or approval from the federal government. Each claim is punishable by a fine between five and ten thousand dollars plus three times the damages the government sustains. A skilled Michigan health care fraud lawyer at The Law Offices of Barton Morris can protect your rights and fight for your best interests.
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