Defending Against Federal Charges for Healthcare Fraud in Georgia

Defending Against Federal Charges for Healthcare Fraud in Georgia

The federal government takes healthcare fraud seriously. The stakes are high for individuals or organizations facing these charges. Healthcare fraud cases typically involve complex laws, substantial evidence, and powerful federal agencies, such as the Department of Justice (DOJ), the Office of Inspector General (OIG) for the Department of Health and Human Services, or the FBI. Potential consequences may include professional disqualification, financial ruin, and years in prison. However, an accusation does not necessarily mean a conviction. Challenging the allegations and protecting your rights with a robust legal defense is possible.

What Is Healthcare Fraud?

Healthcare fraud involves intentional acts to defraud the healthcare system, usually Medicaid, Medicare, or private insurers. It may be committed by medical providers, patients, or others. Fraudulent acts may include overbilling, submitting false claims, receiving referral kickbacks, or falsifying medical records to justify unnecessary prescriptions or treatments. The FBI is the primary investigating agency for healthcare fraud in the U.S. Healthcare providers operate in a maze of regulations, and even innocent errors in documentation or billing can draw federal scrutiny. Once an investigation is launched, the matter can escalate quickly.
In Georgia, healthcare fraud cases often arise in the following contexts:

• Upcoding: Billing for more expensive procedures than the ones that were performed.
• Phantom billing: Charging for services that were never rendered.
• Prescription fraud: Filling or writing prescriptions for drugs a patient doesn’t need, often controlled substances.
• Kickbacks: Offering or accepting illegal payments for patient referrals.

What Makes Healthcare Fraud a Federal Matter?

Healthcare fraud cases that involve federal programs such as Medicaid or Medicare often fall under federal jurisdiction. Federal laws such as the False Claims Act, the Anti-Kickback Statute (42 U.S.C. Section 1320a-7b(b), and the Physician Self-Referral Law (commonly known as the Stark Law) reflect the aggressive stance of the federal government on these crimes. Convictions under these statutes can lead to severe penalties, which may include the following:

• Prison sentences range in length from months to decades
• Fines of up to three times the amount of the fraudulent claims
• Exclusion from federal healthcare programs or loss of medical licenses

What Makes Georgia Healthcare Providers Vulnerable?

Georgia’s growing healthcare industry, combined with increased scrutiny of Medicare and Medicaid claims, makes healthcare providers in the state vulnerable to fraud investigations. Federal prosecutors in Georgia’s districts are experienced in healthcare fraud cases and often use sophisticated data analytics to identify irregular billing patterns. Even minor discrepancies can trigger an investigation.

What Are the Key Considerations in Defending Against Federal Healthcare Fraud Charges?

Every detail matters when you face federal charges of healthcare fraud. Prosecutions rely on large volumes of evidence, including billing records, emails, and testimony from whistleblowers. A strong defense requires an in-depth understanding of healthcare laws and the ability to dissect and challenge the government’s narrative. The following are key components of a strong defense strategy:

Challenging the Government’s Evidence

Federal prosecutors must prove their cases beyond a reasonable doubt, and every piece of evidence must withstand scrutiny. A skilled criminal defense lawyer can challenge the following aspects of the prosecution’s case:

• Billing records: Were the records interpreted correctly? Errors in medical coding are common and not necessarily indicative of fraud.
• Witness testimony: Former employees and whistleblowers may have personal grievances, financial incentives under the False Claims Act, or other ulterior motives.
• Intent: For fraud to be committed, there must be intentional wrongdoing. Demonstrating that errors were unintentional or resulted from improper training can undermine the prosecution’s case.

Proving Efforts to Comply

Demonstrating that you made a good-faith effort to comply with all applicable laws and regulations is one of the most effective defenses against healthcare fraud charges. If you show that you took proactive steps to follow the law, it can help refute allegations of deliberate fraud. These steps may include the following:

• Training staff on proper billing practices and implementing compliance programs
• Conducting internal audits to identify and correct errors
• Consulting with legal or regulatory experts to help you navigate complex rules

Questioning the Government’s Interpretation of the Law

Healthcare regulations are complex and often open to interpretation. The government may identify a legitimate business practice as fraud if the actions fall within a gray area of the law. Some cases hinge on how a particular regulation should be applied to a specific set of facts. An experienced criminal defense lawyer can challenge the government’s interpretation and argue that no violation occurred.

Negotiating a Plea Agreement or Dismissal

A seasoned criminal defense attorney can assess the strength of the prosecution’s care and explore opportunities to reach a favorable resolution. In some cases, it may be in the client’s best interests to negotiate with prosecutors to reduce charges or penalties. In other cases, pretrial motions to suppress evidence or dismiss the case may be appropriate.

Why Choose Our Firm?

If you face healthcare fraud charges in Georgia, our white-collar criminal defense lawyers at Mones Law P.C. can help you navigate this complex legal issue. Our legal team is experienced, aggressive, and trial-focused. We can ensure your rights are protected and develop a robust case for your defense and will vigorously pursue the best possible outcome in your case. Contact us to schedule a free consultation at 678-616-2647.