Health Care Fraud

If you are under investigation for 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. healthcare 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 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. 

Defense attorney for health care fraud defense in the Bay Area

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 the ability to practice your profession, along with damage to your reputation as a healthcare provider.

Types of health care fraud and abuse

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 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.
• 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.
• Over-charging 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

Healthcare fraud defense in San Francisco

A healthcare 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 healthcare 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 healthcare programs they monitor and is a federal healthcare law enforcement agency. 

Why choose us?

Our legal team at Hickey & Chung is skilled, passionate, and effective. We are dedicated to helping our clients facing healthcare 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.