If you believe you may be under federal investigation for a Healthcare Fraud Case, it is critical that you hire a qualified criminal defense attorney right away. Do not risk having your rights violated by neglecting to retain a skilled, experienced criminal defense attorney.
The Houston, Texas law office of Kuniansky & Associates will work diligently to ensure your rights are protected.

State and federal law enforcement have increased efforts to crack down on healthcare fraud and even excessive regulatory intervention. As a result, more and more doctors and other healthcare professionals find themselves under investigation for crimes they did not commit. This often results in professional repercussions as well, leading to disciplinary actions or the revocation of a doctor's license.

With tightening budgets comes ever more intrusive regulatory investigations, the pursuit of healthcare fraud and abuse has also heightened, and claims of abuse are more widespread than ever. Almost any practitioner engages in treatment and billing activities which could be challenged by regulators, no matter how hard the doctor works to be honest, if an eager investigator puts the right "spin" on the conduct. Too often it becomes a question of who is looking and how aggressive they are, not whether someone is trying to cheat the system. The Justice Department has expanded its Special Task Force across the country to pursue cases of Medicare fraud.

Federal, state, and private payers have grown far more aggressive against healthcare providers who are seen to have "crossed the line" in treatment decisions and billings; while some are cutting corners, many are completely honest. Remember, whether it is viewed as a "mistake" or a "crime" is too often based on subjective analyses. As healthcare payers push harder to uncover improprieties, healthcare fraud attorneys also need to become more aggressive.

Medicare & Medicaid Fraud:
Overbilling, Upcoding, Unbundling and Healthcare Fraud

In most overbilling healthcare fraud cases, the Current Procedural Terminology (CPT) codes or the Healthcare Common Procedure Coding System (HCPCS) is involved. Even for a seasoned healthcare or insurance professional, the CPT and HCPCS codes can be difficult and even perilous to try to understand and master. As a result, a healthcare provider may consistently make the same kind of mistake in using CPT or HCPCS codes when billing Medicare or Medicaid. Unfortunately, to an overzealous investigator, what is in reality an honest mistake may instead be converted into a claim of a pattern of fraud: the CPT code for an initial office visit is not straight forward when the medical service provided and the length of the office visit is taken into account.

Over-Prescribing Drugs Cases

In an effort to combat healthcare fraud, state and federal prosecutors have increased criminal prosecutions of doctors involving the over-prescribing of drugs. While most cases involve the prescription of opiates and powerful pain medication like Oxycontin, investigators have also pursued cases involving what they say is excessive infusion drug therapies. Allegations typically claim the drugs prescribed exceeded a patient's need, resulting in a violation under federal statutes. These charges unfairly put the practitioner in the same "class" as heroin or cocaine dealers.

The punishment for a conviction of health care fraud includes: Imprisonment in state prison or jail, loss of professional license, parole or probation, substantial fines and court costs, restitution that could include all monies collect from insurance agencies, an inability to be a Medicare or Medi-Cal provider in the future.

In most cases, law enforcement is working hand in hand with local prosecutors to assemble a substantial case against a health care provider. Often, health care professionals already know they are under investigation because they may have had search warrants executed at their work place, home, or bank accounts. After a search, it will take a substantial amount of time before charges are filed.

 

 

If you are a health care provider or work in the medical field and have been investigated, arrested or charged with a health care fraud offense, it is critical to your case that you hire a qualified criminal defense attorney right away. Do not risk having your rights violated by neglecting to retain a skilled, experienced criminal defense attorney. The Houston, Texas law office of Kuniansky & Associates will work diligently to ensure your rights are protected.

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