Healthcare fraud laws aim to protect the integrity of the healthcare system and prevent the misuse of funds allocated for healthcare services. These laws are primarily enforced by the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), and violations can lead to severe penalties, including fines, exclusion from federal healthcare programs, and even imprisonment. This is why it’s crucial to seek the guidance of experienced healthcare attorneys. Here, we have listed some situations when you should call an experienced healthcare attorney for guidance.
When Facing Accusations of Illegal Referrals
If you’re facing allegations of kickbacks or illegal referrals, it’s crucial to contact a healthcare defense attorney. These types of violations are prohibited by laws such as the Anti-Kickback Statute and the Stark Law, but the nuances and differences between them may be difficult to understand without specialized experience in healthcare fraud. Only an experienced healthcare defense attorney would be able to advise you on the specific details of these laws, and how they apply to your situation. One example of nuance is that while the Anti-Kickback Statute requires conduct to be “knowing and willful” for a violation to occur, the Stark Law does not. This means that a violation of the Stark Law can occur even if the physician did not intend to break the law.
When Internal Compliance Investigations Are Needed
We have already seen how complicated the laws related to healthcare fraud can be. Given that, it is necessary that every healthcare provider conducts an internal compliance investigation periodically to ensure that they are not in violation of any of the healthcare fraud laws — both federal and state. Additionally, such internal investigations help prevent any violations or stop ongoing violations, create documents that show your good-faith response, promote transparency, protect management from allegations of complicity, etc. Such investigations include witness interviews, self-disclosure, expert input, identifying conflicts of interest, etc. These are expert procedures that only an experienced healthcare attorney will be able to handle efficiently.
When Accused of Healthcare Fraud Conspiracy
When multiple individuals are implicated in a healthcare violation, the government may bring conspiracy charges. These charges do not require the success of the conspiracy or the accomplishment of the goal for a conviction to occur. Instead, the government must simply prove that an agreement to violate a healthcare fraud law existed. The severity of this charge can result in a sentence of up to 10 year in prison. It is crucial to understand that the government does not need to prove that the defendants succeeded or even took any action towards the violation. This is why it is crucial to have the guidance and representation of an experienced healthcare defense attorney, who can help defend you against such charges by challenging the evidence presented, or seeking alternative sentencing options.
