Healthcare and Medicare Fraud

Experienced Representation in Fraud and White Collar Criminal Defense Cases

Health care is a big business in the state of Michigan and across the U.S. The cost of medical treatment can be very high, and most people depend on either private health insurance or the government to pay most of their health care costs. There are many temptations – and opportunities – to attempt to cheat the system, whether by consumers or by providers. But healthcare can also be complex for citizens and can result in misunderstandings.

If you are under investigation for suspected criminal activity, you are facing a big problem. You need an experienced attorney to advocate on your behalf.

We are 100 percent dedicated to the practice of criminal defense and we are 100 percent committed to helping you get the best possible results. Call or text us at (248) 310-3399, or contact us online.

Healthcare/Medicare Fraud

Medicare fraud, also known as healthcare fraud, includes any fraudulent or misrepresented action taken against federal government programs for monetary or pecuniary gain. Some of these programs include Medicare, Medicaid, or the Department of Labor. The government has introduced various statutes and regulations with the intention of preventing specific types of fraud.

  • The Anti-Kickback statute prohibits healthcare providers and business owners from giving or receiving remuneration in order to secure patient referrals. Violating this statute can subject a person to prosecution for healthcare fraud by the government.
  • The Stark Law prohibits referrals made on the basis of monetary incentive. this would apply to physicians referring patients to a specific health service entity that the physician has ownership interest in or any sort of arrangement with for money.
  • The False Claims Act (FCA) provides that any person who knowingly submits false claims for payment or approval to the government is liable of healthcare fraud. in order to be proven it must be shown that the claim made was indeed false and that the defendant took action knowing that the representation was false, such as a false record or statement material. If guilty a person can be liable for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages which the government sustains.
Criminal Healthcare Fraud

The criminal healthcare fraud statute provides penalties as put to 10 years in prison for each count of healthcare fraud. It also carries up to 20 years in prison if the fraud resulted in serious bodily injury. Additionally, it can also carry up to life in prison if the fraudulent scheme resulted in the patient’s death.

Insurance Fraud

Insurance fraud is when someone provides false information to an insurance company in order to gain something of value that he or she would not receive if the truth has been told. In Michigan, this act is a felony. If convicted of insurance fraud a person can receive prison time, fines, legal fees and more as penalty for the crime.

Some examples insurance fraud include:

  • Inflating a claim to get out of paying deductible or to cover past insurance premiums
  • Orchestrating the destruction of an owned automobile, home or business to collect insurance
  • Exaggerating the extent of a minor injury to collect workers’ compensation benefits
  • Billing insurance companies for medical services that were not rendered
500.4511 Violation as Felony

A person who commits a fraudulent insurance act under section 4503 is guilty of a felony punishable by imprisonment for not more than 4 years or a fine of not more than $50,000.00, or both, and shall be ordered to pay restitution.

A person who enters into an agreement or conspiracy to commit a fraudulent insurance act under section 4503 is guilty of a felony, punishable by imprisonment for not more than 10 years or by a fine of not more than $50,000.00, or both, and shall be ordered to pay restitution.

If the court finds a practitioner or insurer responsible for, or guilty of, a fraudulent insurance act under section 4503, the court shall notify the appropriate licensing authority.

Contact Our Royal Oak Law Office

We provide the personal attention and respect our clients need and deserve. When you hire us, you get us, not a junior associate or a paralegal. Call or text us at (248) 310-3399, or contact us online. We have our mobiles on us at all times, so you can expect a prompt response. The sooner you contact us, the sooner we can get to work building you a strong defense.

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