Criminal Defense for Healthcare Fraud

Allegations of healthcare fraud can lead to criminal indictments, investigations related to criminal sanctions and the loss of a career. The attorneys at Norman Spencer Law Group have been representing licensed healthcare professionals and healthcare entities for the past decade, with criminal defense as one of our focus areas.

Our experienced healthcare lawyers aggressively defend our clients, supporting them from initial investigation through the trial. We handle federal and state criminal matters, including investigations launched by the Department of Justice, FBI, FDA, DEA and Health and Human Services. We also conduct internal investigations on behalf of our clients who require an investigation to follow-up on credible allegations of fraud.

While many attorneys may be well-versed in criminal matters or professional licensing healthcare matters, the legal team at Norman Spencer Law Group has extensive experience in both. We are dedicated to the staunch defense of healthcare professionals and entities, and we handle both the criminal and administrative proceedings.

When licensed healthcare professionals are charged with a crime, they must defend their actions in criminal court as well as before the state licensing board associated with their profession. These proceedings are subjected to two specific areas of law: the state Penal Code for the criminal charges and the Public Health Code for the administrative matters.

Our healthcare attorneys understand that criminal charges typically result in administrative or professional licensing actions. That’s why we offer a comprehensive defense that covers both areas. We aim to not only make the process as straightforward as possible for our clients, but to also make sure any criminal convictions are dealt with in a manner that limits the impact on their professional license.

Unfortunately, criminal cases handled by defense attorneys that are unfamiliar with administrative law often plead cases in a manner that makes it difficult to avoid licensing action. The state and professional licensing boards often have no choice but to place limitations on licenses if certain criminal convictions are upheld.

Your professional license is a major consideration from the onset of your representation. We develop our strategy with a client’s license consistently at the top of our minds, then move forward to aggressively represent them during their criminal and administrative proceedings.

While the legal team at Norman Spencer Law Group has represented licensed healthcare professionals in a variety of cases, some of the most common we encounter include:

• Healthcare fraud
• Medicaid and Medicare fraud
• Home healthcare fraud
• Drug diversion
• DEA matters

Healthcare fraud covers a wide range of charges, including kickbacks, patient brokering, Stark law, false claims and fee-splitting.

Kickbacks: Kickbacks refer to payments, services or products healthcare providers accept in exchange for soliciting business for Medicare or other healthcare programs.

Medicaid and Medicare fraud: Many types of Medicaid and Medicare fraud can be committed, with examples that include:

• Mistreating or abusing patients
• Billing for services not provided
• Billing for services individually when they are typically charged as a package rate
• Providing unnecessary referrals
• Performing unnecessary tests
• Filing reimbursement claims when claimant is not eligible or entitled

Patient brokering: Patient brokering is the act of paying a third party to bring a patient into your healthcare practice or establishment.

Stark Law: This healthcare fraud law bans healthcare professionals from referring patients for certain Medicare-covered services to any establishment or entity with which they have a financial relationship.

False claims: As a federal law, the False Claims Act prohibits individuals or entities from knowingly filing a false claim or creating a false record with regard to any federal healthcare program.

Fee splitting: Fee splitting refers to the practice of sharing fees with other professionals in exchange for being sent referrals. Other professionals can be in any field, not just the healthcare arena.

Criminal healthcare fraud charges can lead to severe consequences for those convicted. Penalties can be harsh at both the federal and state levels, and they can include prison terms of up to 20 years and fines in the hundreds of thousands of dollars. If a healthcare entity is convicted of multiple criminal charges, it may end up with fines stretching into the millions, or even billions, of dollars.

In addition to any fines, defendants may also be ordered to pay back the amount of money they illegally acquired as a result of their fraudulent acts. Probation is another possible penalty, with probation periods typically lasting at least one year.

When our clients are facing criminal charges, we combine our deep criminal law experience with our vast standard-of-care knowledge to develop a strong and comprehensive defense. Regardless of the criminal charges clients may be facing, we are always ready to assist. The sooner you contact an experienced healthcare team, the better. Call our office to schedule a consultation today.