Health Care Fraud Pennsylvania | Ketchel Law - Criminal Lawyers Pittsburgh

Facing Federal Health Care Fraud Charges?

When you are charged with federal health care fraud, the future may seem daunting, especially when your career is at stake.

Federal Healthcare Fraud is governed by different acts and each face their own punishments if convicted—the consequences of which have the ability to cause financial and career ruin.

If you have been charged with healthcare fraud or are under investigation for healthcare fraud, you need an attorney who is licensed in both federal and state court. In addition, to properly fight your charges, you need someone experienced and capable of protecting your career and your future.

An Arrest is Not a Conviction

At Ketchel Law, we are Federal Crime Attorneys well-versed in both state and federal court systems. We can help you understand your rights and options to fight your charges.

If you were indicted on a federal crime, or think you may be charged or are under investigation, contact Attorney Justin J. Ketchel immediately for a free case evaluation.

OUR NUMBER ONE GOAL: GETTING YOUR FEDERAL CHARGES DISMISSED.

Call 412-456-1221 for a free consultation

PITTSBURGH FEDERAL CRIME LAWYERS

FEDERAL HEALTHCARE FRAUD EXPLAINED

Healthcare fraud does not only apply to doctors. Anyone who is in the healthcare field can be charged with healthcare fraud. This includes doctors, physician’s assistants, urgent care providers, home health agencies and pharmacists.

Billing mistakes can occur frequently in the healthcare industry. However, those held accountable for healthcare fraud violations usually have a history of widespread, systematic and financially significant impact. Sometimes the case can be brought on by a whistleblower, often a former employee. Or, what begins as a simple investigation into billing issue or irregularities reveal larger violations that lead to civil or criminal charges.

The U.S. federal laws under 18 USC 1347 defines federal health care fraud as anyone who knowingly and willfully executes, or attempts to execute, a scheme or artifice:

To defraud any health care program; or
To obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.

Fraud is a very broad term to define a willful, often planned theft by means of deception—generally by a person in a position of trust. Therefore, there are a number of actions that give cause to violate healthcare statutes.

The most common violations of health care fraud include:

Kickbacks/referral fees;
Submitting false claims;
Filing duplicate claims;
Modifying medical records;
Billing for services or equipment not provided to the patient;
Billing for ghost patients;
Upcoding;
Performing services with lack of medical necessity;
Making false statement to participate in Medicare or Medicaid.

Healthcare fraud cases are broadly overseen by the FBI. However, they often partner with other agencies in order to investigate and expose the fraud.

They frequently partner with Health and Human Services, the Food and Drug Administration, the Drug Enforcement Agency and the Internal Revenue Service, as well as state and local agencies.

In some cases, violators may be charged with other crimes depending on the circumstances surrounding the fraud.

For example, if a number of people were involved in carrying out the scheme, they all may be charged with conspiracy. If mail or electronic mail was used to carry out the fraudulent acts, they may be charged with Mail Fraud.

Each additional charge carries its own separate penalty if convicted. This could mean serving a number of years in federal prison and numerous additional fines.

Remember, being charged with a crime, does not mean that you will be convicted. It is extremely important that you are represented properly throughout the duration of your case.

If you suspect you are under investigation for a federal crime, you should speak to an attorney as soon as possible.

For a free evaluation of your case, please call Attorney Justin Ketchel today at 412-456-1221.

OUR NUMBER ONE GOAL: GETTING YOUR FEDERAL CHARGES DISMISSED.

Call 412-456-1221 for a free consultation

PITTSBURGH FEDERAL CRIME LAWYERS

Penalties for Federal Healthcare Fraud

If you are convicted of a federal healthcare fraud crime, you may face civil penalties, criminal penalties, or both. The type of punishment received will depend on the nature and severity of the fraud, and which statute(s) was violated. You can face jail time, fines, exclusion from federal healthcare programs and the loss of your medical license,

For a conviction under 18 USC 1347, the statute governing federal healthcare fraud, you can receive up to ten years in prison as well as fines, and loss of license.

If you violated the False Claims Act (FCA) or the Stark Act, your penalties will be limited to civil penalties. However, they will impact you financially for years to come. These are strict liability statutes, meaning that they do not have to prove intent in order to find you liable for a violation.

If you are found to have violated the FCA, you can be responsible for treble (triple) damages, as well as potential exclusion from federal healthcare programs, and possible loss of medical license. A violation of the Stark Act requires you to refund whatever amount you gained in addition to up to $15,000 in fines per service as well as exclusion from Medicare.

While you do not face jail time with the civil penalties, they are strict and will likely cause financial trouble for years to come and have potential to end your medical career.

You can also be punished criminally for healthcare fraud. Under the Anti-Kickback Statute, you can receive up to five years in federal prison and up to $25,000 in fines.

For Violations of the Criminal Healthcare Fraud Statute, you can receive up to ten years in federal prison and up to $500,000 in fines, or up to twice as much as the amount defrauded.

How Ketchel Law Can Help

We will stick with you from start to finish.

At Ketchel Law, our greatest strength lies in critically analyzing and dissecting the details of your case and looking for inherent weaknesses and questioning the testimony of any experts or witnesses.

From the moment you engage Ketchel Law to represent you, we will work tirelessly to ensure every aspect of your defense is addressed at every phase. We will make certain you understand your rights and options so that you are prepared at every turn. From pre-trial hearings through the trial and beyond, we will fight to have your charges dropped or significantly reduced.

OUR NUMBER ONE GOAL: GETTING YOUR CHARGES DISMISSED.

CALL KETCHEL LAW TODAY: 412-456-1221

With vast differences between state and federal cases, it is extremely important that you have a knowledgeable and experienced federal crimes attorney on your side. We understand what you are going through and will tirelessly fight on your behalf to ensure that your arrest has a minimal impact on every aspect of your life.

An aggressive and meticulous attorney will gather all evidence and facts about your case, presenting your history to make the best possible defense.

We will attempt to discredit evidence not in your favor and work closely with you to find the best course of action in defending your rights and your freedom.

Learn more about Ketchel Law:

CALL KETCHEL LAW NOW FOR A FREE LEGAL CONSULTATION AT 412-456-1221.

OUR NUMBER ONE GOAL: GETTING YOUR CHARGES DISMISSED.

CALL KETCHEL LAW TODAY: 412-456-1221

FREE CONSULTATION