Federal law (18 U.S.C. § 1347) declares that a person can be found guilty of health care fraud if he/she knowingly and willfully executes, or attempts to execute, a scheme or artifice (1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services.

These types of healthcare fraud cases include over-billing, billing for services which were not rendered, unreasonable billing and unreasonable rates of services, personal kickbacks, and unnecessary treatment. Many of these billing fraud cases will relate to bills and invoices for Medicare and Medicaid programs. Furthermore, violating the Food, Drug and Cosmetic Act or the federal Anti-Kickback Statute also constitutes a violation of § 1347, exposing that person to additional liability.

The Department of Justice and the Department of Health and Human Services are committed to stopping health care fraud both through new means of preventing fraud as well as implementing better methods of fraud detection. To achieve these goals, these departments have put together anti-fraud task forces that are aggressively seeking both criminal convictions and civil actions against those abusing the system.

These efforts have already resulted in charges being filed against over 1,000 defendants and the recovery of billions of dollars. If you believe you are being investigated for health care fraud, the stakes are extremely high. You need an experienced defense attorney to help you fight fraud allegations. Call me for a FREE consultation.