Health Care Fraud

Health care is a big business in the State of Florida and across the U.S. The cost of medical treatment can be very high, and most people depend on either private health insurance or the government to pay most of their health care costs. In an industry that accounts for about 17% of the nation’s gross domestic product, there are many temptations – and opportunities – to attempt to cheat the system, whether by consumers or by providers. Health care fraud costs taxpayers and businesses billions of dollars annually, leading state and federal prosecutors to pursue these cases with increasing fervor. Clearwater health care fraud lawyer Will Hanlon at Hanlon Law has been defending Floridians accused of fraud and other white collar crimes for over two decades.

“Fraud” is a broad term that includes many different types of dishonesty aimed at securing monetary or personal gain for the perpetrator. The traditional definition of fraud involves the misrepresentation of a material fact by someone who knows that the statement is false to a person or entity that justifiably relies on the statement, and there must also be an actual injury resulting from the reliance on the falsehood. Fraud may be both a civil wrong and a crime in many cases. A perpetrator of fraud faces not only criminal prosecution by the state or federal government but also the possibility of a civil lawsuit if the alleged victim chooses to sue for damages. (The criminal court may also order restitution, which may offset the damages owed in the civil case.)

Health care fraud can be perpetrated either by a person or entity that provides services or by an individual who seeks to obtain services. A health care fraud attorney in Clearwater can assist defendants in either of these situations. Some of the more common types of fraud alleged against providers of services include billing for services that were not actually rendered to a patient, upcoding of services or items, duplication of claims for services, and providing unnecessary services. Kickbacks – a form of negotiated bribery – are also considered a form of health care fraud. Patients may commit other types of health care fraud, including using deception to secure medical treatment, prescription drugs, or other services.

Jail time for an act of health care fraud can be substantial. Depending upon the particular illegal act, a defendant could face five years, 10 years, 20 years, or even life in prison. False Claims Act convictions can be especially harsh when the defendant engaged in multiple acts of fraud. Civil penalties can also be very costly, mounting as high as $250,000 in some cases. In addition, a licensed professional such as a doctor or nurse faces the loss of their license, exclusion from Medicare or Medicaid programs, and the loss of staff privileges. Because of the severity of the consequences for a health care fraud conviction, it is imperative that the defendant in such a case obtain a qualified criminal attorney who can help them explore possible defenses, such as a constitutional violation during the investigative phase of the case, entrapment, mistake, or a failure of the prosecution to prove the elements of the crime beyond a reasonable doubt.

A conviction of any crime can have far-ranging consequences, but this is especially true for fraud cases and for health care fraud in particular. A conviction can take away the defendant’s freedom for many years, wreak financial havoc, and adversely affect their ability to make a living for decades to come. Since these types of cases hinge largely on the details, it is important to retain a white collar crime attorney who has the time and ability to uncover the many layers of complexity, looking for possible defenses or weaknesses in the State’s case. To schedule an appointment with Clearwater health care fraud attorney Will Hanlon at Hanlon Law, call us today at 727.897.5413 or contact us online. We also represent people in cities such as Newport Richey and Dade City.