At the mention of federal healthcare fraud, many people think of crimes such as basic kickbacks, where an individual earns money for referring someone to a particular provider. However, these charges describe a broad area of criminal offenses. For example, a medical provider might be federally charged due to billing for services that were not rendered, submitting duplicate claims, up-coding items inappropriately, or providing medically unnecessary services.
Currently, federal agencies are expending many resources on the enforcement of regulations against healthcare fraud. Because there is often a large financial recovery involved, the government heavily investigates and prosecutes these types of criminal cases. As such, anyone accused of federal healthcare fraud in Charleston should contact a dedicated defense attorney to combat the potentially aggressive prosecution.
Who Investigates Federal Healthcare Fraud Cases in Charleston?
There are multiple agencies that could carry out a federal healthcare fraud investigation, including the FBI or Health and Human Services. For cases in Charleston, the South Carolina Attorney General’s Office is also often involved, depending on the specifics of the allegations.
Investigation Process
Charleston residents or entities who are being investigated for federal healthcare crimes may first receive a target letter from the government indicating their suspicions. Anyone who is sent this notification should reach out to an experienced local attorney as soon as possible for advice on how to best approach the potential investigation.
In cases involving Medicare providers, the government may demand that they stop providing services, which can have disastrous financial effects for a business. In this way, these types of federal investigations can be uniquely devastating because they impact the livelihoods of the people targeted. However, having immediate legal counsel may allow Charleston healthcare providers to keep their businesses operating while they are trying to resolve the investigations against them.
Prosecution in Healthcare Fraud Cases
In order to prosecute a Charleston healthcare provider for fraud, the government will typically need to prove that they intentionally engaged in fraudulent conduct or made false claims. In making their case, the prosecution team may rely on billing records, statements made by other healthcare workers, or IRS records. As such, prosecuting federal healthcare fraud charges can be particularly document-intensive.
The prosecution may attempt to prove intent by analyzing these documents. If they find a number of miscoded cases, they may use that as evidence that the person had fraudulent intentions. Alternatively, the government may speak to other people who work for the healthcare company. If these employees testify that they were instructed to miscode certain services or charge more than they should have, this could provide strong evidence for a prosecutor’s case.
Federal Penalties for Healthcare Fraud in Charleston
Like many federal cases, the penalties for healthcare fraud cases are dependent on either the actual or the intended loss. This means that the government could seek restitution for either the amount that they believe has been improperly appropriated or the amount that they believe a healthcare provider intended to defraud. Either of these principles could be used in determining the loss amount.
One significant penalty that could accompany these charges is the inability to participate in the healthcare system. If one is convicted of Medicare fraud, they can no longer be a provider. Because federal healthcare fraud is a felony offense, conviction could also carry a number of collateral consequences, such as loss of the right to vote or possess a firearm. Additionally, any federal fraud conviction carries the threat of a potential prison sentence related to the amount of economic loss.
Call an Experienced Attorney to Defend Federal Healthcare Fraud Cases in Charleston
Those facing federal charges of any kind must take these allegations seriously. If you believe you are under investigation for federal healthcare fraud in Charleston, contact a rigorous legal defense team immediately. Because these cases involve many documents and technical language, you need a knowledgeable attorney who is familiar with the information that the government is looking for.
A skilled defense lawyer may also be in a better position to negotiate with the government and levy various legal tactics to help healthcare providers avoid criminal liability. To protect your interests and secure a better chance of a positive resolution to your case, call Adams & Bischoff today to begin building your defense strategy.
