Defending Against Healthcare Fraud Charges
If you’ve received a Medicaid or Medicare fraud letter, or are facing other investigations for healthcare fraud, it’s important to contact an attorney experienced in dealing with handling these allegations.
Medicaid and Medicare Fraud Audits
Attorney George Murphy represents physicians, practices, pharmacists, chiropractors and other medical professionals who are the subject of a Medicaid or Medicare audit, who have received a letter from the government saying they will be the subject of a provider audit.
Having an experienced attorney guide you through the administrative review process can be essential to protecting your interests, removing yourself from suspicion, and heading off trouble in the future.
Defending Against Healthcare Fraud Accusations
When you’ve been accused or are facing the possibility of an investigation for healthcare fraud, getting an experienced defense attorney involved as soon as possible is essential to defending yourself. A strong defense can help preserve your reputation, your professional license, and your livelihood.
Attorney George Murphy is experienced at defending his clients against multiple types of healthcare fraud, including:
- Anti-Kickback accusations
- Overbilling accusations
- Doubling billing accusations
- Unbundling accusations
- Billing for phantom patients
- Billing for services never rendered
- Phantom claims for durable medical equipment
Two Defenses to Anti-Kickback Prosecutions
Many people – including many prosecutors – mistakenly believe that receiving payments alone in return for referring business to a health care provider is illegal. That is simply not the case. For such an act to be a crime, one must ask two additional questions: (1) did the person make or receive the payments “willfully,” that is, did the person know that making payments/receiving money was, indeed, illegal; and, (2) did either person qualify for protection under the law’s “safe-harbor” provisions.
Willfulness: Ignorance of the Law is a Defense
You have heard that ignorance of the law is not a defense in a criminal case. That is true nearly all of the time because most criminal acts are obvious (for example: stealing, selling drugs, assaulting, etc.). However, there are some acts which are not obviously or inherently wrong (for example: accepting money for the referral of a patient to a health care provider) but which the legislature has made a crime. These are the kind of acts which, if not done “willfully,” are usually not crimes.
Courts have not always agreed on what the term “willfully” means. For example, does it mean that a person must know the precise law he is violating or must he be aware only generally that a law prohibits his conduct? Whatever the case, the term “willfully” requires, at a minimum, that a person does not commit a crime unless he knows, on some level, that a law prohibits his conduct and he, nonetheless, sets out to violate that law.
The importance of the legal requirement of willfulness cannot be overstated. It can mean the difference between innocent behavior and guilty behavior, between being charged with a crime and not being charged with a crime, between being acquitted and convicted.
Many people have recently started new businesses in the growing and heavily regulated health care industry. In many cases, it is nearly impossible (or, at least, extremely difficult) to be aware of all one’s legal obligations, including what acts do or do not violate the anti-kickback statute or the health care fraud statute. A failure to follow the law may, indeed, be negligent and can certainly lead to negative administrative or business consequences. However, a failure to follow the complex maze of laws related to receiving or making payments for business referrals in the health care field is not necessarily a crime.
The Safe Harbor
The anti-kickback law is so broadly written that Congress decided to create a series of exceptions to the law which are called “safe harbors.” An act which may violate the anti-kickback law but which also precisely fits within a safe harbor is immune from prosecution. There are roughly 24 safe harbors. One worth mentioning here is the exception made for payments to employees. Payments made by an employer to a bona fide employee – even for referrals – are protected from criminal prosecution.
George Murphy will work hard on your behalf and may be able to bring your situation to a successful conclusion without accusations becoming formal charges and without the case ever going to trial.
Federal Medicare and Medicaid Lawyer
If you’ve been accused of Medicare or Medicaid Fraud, attorney George Murphy will fight hard on your behalf. As a former Assistant District Attorney, George Murphy understands how prosecutors use fraud charges and how to defend his clients against these accusations. Attorney George Murphy will bring the strength of his knowledge of the legal system and years of experience as a courtroom lawyer to your case when you need to defend yourself against healthcare fraud accusations.
When you need someone by your side to defend you against computer fraud or another federal criminal charge, contact federal criminal defense attorney George Murphy by email or call at 713.658.1960.