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The federal government provides financial assistance to certain citizens who need help paying for healthcare, relying on individual providers and facilities to provide this assistance. Physicians and hospitals who accept Medicaid and Medicare are required to follow certain billing guidelines, and those who fail to do so may be charged with health care fraud.

If you or your medical practice are currently being investigated or charged with such an offense, it may be in your best interest to hire a Birmingham healthcare fraud lawyer to defend you. The government aggressively prosecutes those suspected of healthcare fraud, but a skilled federal criminal attorney may be able to help you avoid the harsh penalties that a conviction could bring.

Medicare and Medicaid Fraud

Medicare and Medicaid are government-funded programs that provide elderly, disabled, and low-income individuals with access to a variety of healthcare services. Both programs work closely with medical professionals and facilities to provide this care, and the professionals and facilities they work with must abide by strict guidelines.

If a medical professional or facility commits the following acts, they may be charged with healthcare fraud:

  • Provide inpatient treatment for longer than Medicare or Medicaid agrees to pay for
  • Provide prescriptions that are not approved by Medicare or Medicaid
  • Provide services knowing a lower-cost alternative is available
  • Provide physical therapy or rehabilitation treatment that Medicare or Medicaid deems unnecessary

Government billing guidelines can be complex, and it is possible for physicians and hospitals who are simply trying to provide the best care they can to end up in trouble. If an individual or business is being investigated for Medicare or Medicaid fraud, they should consult a Birmingham healthcare fraud lawyer for personalized advice about their unique situation.

The Federal False Claims Act

The federal False Claims Act allows the government to investigate individuals and organizations suspected of submitting false and fraudulent claims to the federal government. Knowingly submitting false claims, using misleading billing procedures, or simply acting in reckless disregard can lead to a criminal charge.

Medical professionals and facilities typically attract the attention of the federal government in two different ways. First, if a whistleblower provides information, the government can bring forth a qui tam lawsuit. Secondly, if the government notices unusual billing records or trends, they may decide to launch an investigation and charge the individuals determined to be involved.

Unfortunately, the False Claims Act does not provide any guidance regarding individuals who unknowingly or mistakenly submit abnormal claims to the federal government. Legally, these individuals can be placed in the same category as those who knowingly submit false or misleading claims.

How Does the Federal Government Build a Healthcare Fraud Case?

As mentioned previously, it is possible for well-intentioned healthcare providers and facilities to be charged with fraud. When building a case for charges of fraud, investigators often turn to patient records to amass evidence. If any records or tests seem abnormal, they can be used against the accused party in court. The government may also use prescription drug records and election statements to establish a case.

Unfortunately, investigators are often in a rush, and they may overlook important factors when examining patient records. This overreliance on data can cause problems, even if no traditional red flags are present. A Birmingham healthcare fraud lawyer experienced in healthcare fraud cases could work to ensure that all evidence presented at trial is representative and was legally obtained.

Consulting a Birmingham Healthcare Fraud Attorney

If you are currently facing charges of health care fraud, you may be feeling frightened and confused, especially if you attempted to follow the billing guidelines and made an honest mistake. This situation can be frustrating, but with the right attorney on your side, you may be able to achieve a positive resolution to your case. Consult a Birmingham healthcare fraud lawyer today for additional information.

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