A Reliable Defense Of Your Freedoms And Best Interests

Experienced, Practical, Trial-Tested Health Care Fraud Defense

If you are under investigation for federal health care fraud or have reason to believe that you may be investigated in the future, you should immediately seek qualified legal counsel. Due to the complexity of the U.S. health care system and the laws that regulate the industry, you should seek an attorney with substantial health care experience if you are facing a charge of health care fraud.

At Hickey & Chung, LLP, our team of attorneys has represented numerous doctors, nurses, pharmacists and other health care providers and insurers in a range of health care fraud matters, including investigations, jury trials and professional license revocation hearings. Our deep knowledge of both U.S. health care delivery and the attendant laws and regulations has helped us to consistently obtain excellent results for our clients.

Stepping In After Health Care Fraud Allegations

Many types of health care fraud charges have potential defenses, which may not be obvious to health care practitioners, investigators or even defense attorneys. The Anti-Kickback Statute and Stark Laws both have built-in safe harbors that shield practitioners under specific circumstances. Billing fraud can be difficult to prove, in part, because of numerous grey areas in medical coding. In fact, most types of fraud require the government to prove that the defendant acted “willfully,” that is, with the knowledge that their conduct was illegal.

Even in cases where there is sufficient evidence to prove fraud, the potential sentence and severity of collateral consequences are often determined by how the financial “loss” is calculated, which could be subject to government manipulation. Hiring a talented attorney who knows the territory can help you protect your rights and freedoms, and seek to avoid the loss of your medical license and your practice, along with damage to your reputation as a health care provider.

Understanding The Types Of Health Care Fraud Cases

An investigation into a medical practice, clinic or practitioner may be initiated if it is suspected that fraudulent activities are taking place. The types of medical insurance fraud and other health care fraud include, but are not limited to:

  • Misrepresenting the medical services provided
  • Misrepresenting the provider who administered the service
  • Billing for services or items that were never rendered (false claims)
  • Billing for services that were incorrectly documented
  • Billing for services that were not medically necessary
  • Submitting bills for “unbundled” services
  • Pursuing payment for services at a higher rate or “upcoding”
  • Misuse of medical codes on a submitted claim
  • Overcharging either individuals or insurance companies for medical services or medical supplies
  • “Kickback” schemes
  • Allowing nurses or other staff to perform exams
  • Unlawful prescribing or dispensing
  • Misrepresenting dates of service
  • Waiving deductibles or copayments

If a jury finds you guilty, you may face prohibitively expensive fines, license suspension, censorship by professional boards, increased monitoring and other civil penalties. In the worst cases, fraud can also lead to serious jail time, ongoing probation and other criminal penalties.

What Makes Health Care Fraud Unique In The Law

A health care fraud case differs from all other types of criminal charges. The vast number of regulations in the industry require your defense attorney to be experienced and have a great breadth of understanding of the nuances of the health care statutes, Medicare and Medicaid guidelines, and the administrative rules and procedures issued by the OIG (Office of the Inspector General).

The OIG is the federal agency tasked with fighting waste, fraud, and abuse in Medicare and Medicaid and many other Department of Health & Human Services programs. The OIG Office of Investigations conducts criminal investigations of fraud associated with the health care programs they monitor and is a federal health care law enforcement agency.

It Is Time To Schedule An Appointment

Our legal team at Hickey & Chung, LLP, is skilled, passionate and effective. We are dedicated to helping our clients facing health care fraud charges, and we consistently achieve favorable outcomes. Hiring a good lawyer who knows the territory and is deeply familiar with health care cases can help you defend your freedom and protect your professional standing, licensure and ability to practice medicine. Attorney Brendan Hickey is a graduate of Harvard and formerly served as a federal defender. Naomi Chung is a seasoned trial lawyer, recently listed as a SuperLawyers Rising Star. Set up a time to consult with our firm when you call 415-484-4547 or reach out via email.