Healthcare fraud is a serious accusation that may result in thousands of dollars in fines and years of jail time. It is a crime that can be committed by anyone involved in the healthcare system, and whether it was done intentionally or not, having an experienced Arizona healthcare fraud defense lawyer can change the outcome of your case and affect the rest of your life. This is not a situation in which you should test your own criminal defense abilities.
At Suzuki Law, we have experienced attorneys on staff who are familiar with civil and criminal law. Including experience as a previous prosecutor. This gives our firm a unique upper hand when it comes to anticipating the prosecutor’s strategy and providing you with a sound defense.
Defining Healthcare Fraud
It can help to have some background information about exactly what accusations or charges like this mean at the beginning. The Federal Bureau of Investigation explains that healthcare fraud can include numerous behaviors from anyone involved in the healthcare system. Some of these are common, such as billing for services that never happened, and others may be less obvious:
- Unbundling: submitting multiple bills for the same service
- Upcoding: Charging for a more expensive billing code than the service provided
- Identity swapping: Allowing someone else to use your health insurance information to receive services or using someone else’s information for your care
Additionally, employers may commit healthcare fraud when providing benefits to their employees. This may involve enrolling someone who is not eligible for benefits so they can fraudulently receive services. Fraudulent activity may also involve adjusting official hiring or termination dates to extend coverage for an employee who may not otherwise be eligible.
Consequences of Healthcare Fraud
In many cases, healthcare fraud is a federal crime. In recent reporting years, the United States Sentencing Commission reported some quick facts on healthcare fraud offenses, stating that the average sentencing time in recent years is about 30 months. Just under 75% of those convicted served a prison sentence.
Depending on the case, healthcare fraud may result in civil and criminal processes. In some cases, penalties can range from $10,000 to $50,000 per violation regardless of charges being felony vs misdemeanor. In addition to civil penalties and criminal consequences, in most cases of confirmed fraud on behalf of a medical provider, their licensing body will get involved.
If you are accused of fraud as a care provider with a professional or medical license, credible accusations of fraud will frequently be reported to your licensing body when the concern arises. Upon completing an investigation by the licensing body that may include the outcome of any criminal or civil proceedings, you may receive disciplinary action. The specifics of the action will depend upon the governing body, but in many cases, it will mean the restriction or revocation of your license.
Defenses of Arizona Healthcare Fraud Charges
When a case goes to court, it is the duty of the plaintiff (the person making the accusation) to establish the defendant’s guilt (the person being accused). The Arizona judicial branch states that, in criminal cases, the burden of proof is beyond a reasonable doubt. With this standard, your attorney’s job is to instill doubt in the prosecution’s case. This can be done using a few strategies.
Inappropriate Charges
One defense option would be to simply show that the conduct they have proof of does not meet the standard for healthcare fraud. This may be done in a variety of ways, including reasonable ignorance regarding what is occurring. While the federal definition of fraud does not require the act to be willful, it should be done with intentional ignorance or disregard.
Unreliable Witnesses
It is not uncommon to use witnesses to support a case. This may be a witness to testify to company policies and expectations, or it could be someone with whom you spoke about committing illegal acts, among many other scenarios. In many cases, a Tucson criminal defense lawyer may work to discredit the witnesses to encourage doubt in the accuracy of their statements.
Law Enforcement and Prosecution Misconduct
There is an elaborate code of conduct for law enforcement officers regarding how they must behave when conducting an investigation or arrest. If the officer or agent fails to abide by this code, it may provide an opening to discredit much of the case based on illegal investigation practices. This can, yet again, instill doubt in the jury regarding the accuracy or ethics of those working against you.
Prosecution misconduct as a defense is meant to say that the case has been somehow mishandled by the prosecution. This may be some kind of conflict of interest, poor conduct when disclosing evidence regarding your case, or many other behaviors. If our firm is able to establish prosecutorial misconduct, the chances of your case being dropped increase substantially.
Suppressing Evidence
Suppressing the evidence against you can frequently come with law enforcement misconduct. If there is proof that the evidence was collected illegally or mishandled somehow, this may allow our attorney to suppress that evidence. Any evidence against you that cannot be presented can work to your benefit.
Insufficient Evidence
Using insufficient evidence as a defense in your case simply means that you are arguing that the evidence the prosecution has against you does not establish your guilt beyond a reasonable doubt. It may also include suggesting alternative narratives. Suggesting alternative narratives that also fit with the proof provided may highlight the lack of evidence of your behavior.
Arizona Healthcare Fraud Defenses
Any attorney will tell you that each case is different. There may be general principles and claims that are similar or the same as other cases, but each one should be looked at as having its own needs. At Suzuki Law, we will work with you to develop a comprehensive and individualized strategy to defend your rights in court.
If you are facing charges of healthcare fraud, it is essential that you secure representation right away to protect your rights. You can request a complimentary case consultation to evaluate your legal options. Don’t hesitate to call Suzuki Law Offices today.
Call or text (602) 682-5270 or complete a Free Case Evaluation form