Health Care Fraud Attorney in Michigan

The health care industry, much like the financial industry, is one where public confidence is crucial, and the overwhelming majority of health care and medical providers are honest, ethical, and hard workers. At the same time, however, there are many medical providers who seek to bolster the size of their bank accounts at the expense of their patients, insurance providers, and others. In fact, National Health Care Anti-Fraud Association (NHCAA) states that the financial losses due to health care fraud include tens of billions of dollars every year.

Because of these huge financial losses, the FBI and other federal agents and prosecutors relentlessly investigate, pursue, and prosecute individuals involved in health care fraud schemes. When facing the long-term and severe consequences associated with a conviction, alleged offenders need to contact an experienced health care fraud attorney immediately. At Grabel & Associates, our federal crimes lawyers boast extensive experience in fraud cases as well as other federal crimes, and we provide an aggressive, no-stones-unturned approach when fighting for a beneficial outcome for our clients.

What is Health Care Fraud?

At its core, health care fraud is essentially the use of false or misleading information in order to determine the amount of health care benefits payable. It is considered a white-collar crime and, due to the inherent nature of these fraudulent schemes, the fraudster is able to gain financial wealth by passing the costs along to customers and insurance providers. This type of fraud is a widespread problem, as well as being socially and financially disastrous. For this reason, among others, the FBI, U.S. Postal Service, and the Office of the Inspector General are all tasked with investigating health care fraud.

One important aspect of health care fraud, and part of the reason that federal agents heavily prosecute it, is the impact of this fraud on insurance policy holders and consumers. Fraud inevitably leads to higher premiums, higher out-of-pocket expenses, and reduced benefits and coverage.

Common Types of Health Care Fraud

To get a better idea at what constitutes health care fraud, it can be helpful to look at some common examples. Theft of patient information is among the most prevalent forms of health care fraud, and in this scheme, the medical providers use that information to obtain reimbursement for services and goods not provided. Some ways that criminals conduct this fraud include:

Providing inducements, whether in cash or gifts, to get beneficiaries to go to a specific clinic where patient identities are obtained

Obtaining patient information at free screenings (such as at health fairs)Inducing medical personnel to copy patient insurance information and provide it to individuals involved in a schemePurchasing patient information from other individuals involved in the scheme

  • In addition to billing for products or services not provided, other ways that individuals commit health care fraud include:
  • Billing for more expensive services or procedures than were actually performed
  • Performing medically unnecessary services for the purpose of generating insurance payments
  • Falsifying a patient’s diagnosis to justify tests, surgeries, or other services
  • Billing each step of the procedure as if it were a separate procedure
  • Accepting kickbacks for patient referrals

Some types of health care fraud can be quite subtle as well. For example, there was one case where Alzheimer patients were placed in a room every day to watch the same movie. On their bills, they were being charged for group therapy.

Potential Punishments for Health Care Fraud

Individuals convicted of health care fraud may be facing extensive penalties, including large fines and years behind bars. According to 18 U.S. Code § 1347, if you were found defrauding the health care system “in connection with the delivery of or payment for health care benefits, items, or services,” you could be facing fines, imprisonment for up to 10 years, or both. Furthermore, because this type of fraud is associated with health care, and thus a patient’s well-being, there are aggravated penalties as well, including:

  • If the fraud resulted in serious injury, the offender could be facing up to 20 years in prison.
  • If the fraud resulted in death, the offender could be facing up to life in prison.

For a Free Consultation, Contact Grabel & Associates Today

In most cases of health care fraud, the prosecution has to prove, beyond a reasonable doubt, two essential aspects. The prosecution must prove that 1) the defendant knowingly and willfully executed a scheme designed to defraud any health care benefit program and that 2) the scheme was designed to obtain any of the money or property associated with the health care benefit program. In other words, the prosecution has the burden of proof, and by getting an esteemed and diligent criminal defense attorney at your side, you can better challenge these claims.

At Grabel & Associates, our fraud defense lawyers boast extensive experience in federal fraud cases, and we will challenge the prosecution’s narrative and evidence from every angle. Additionally, using our large network of resources, we will seek to develop evidence of our own to prove your innocence, get the charges dropped, or, if the evidence is truly stacked against you, seek reduced or alternative sentencing.

For a free consultation with the attorneys at Grabel & Associates, contact our federal crimes law firm today at 1-800-342-7896.