Health care fraud charges can end in decades in prison and hundreds of thousands of dollars in fines. When the stakes are this high, you need an experienced legal team on your side protecting you from life-altering outcomes. Although federal investigations and charges can be intimidating, accusations alone don’t automatically mean the government can prove that you did anything wrong.
With over 250 years of combined legal experience, the dedicated team at the Law Offices of Jonathan F. Marshall can defend you against federal health care fraud charges in New Jersey and federal courts throughout the region. If you need guidance from federal health care fraud lawyers who understand the most effective defense strategies against these charges, contact us today for your free consultation.
What Is Federal Health Care Fraud?
Federal health care fraud involves knowingly submitting false information to obtain money from a health care benefit program. Under the federal health care fraud statute, the government must prove that a person knowingly and willfully executed (or attempted to execute) a scheme to defraud a benefit program or get money through false or fraudulent representations. This can include:
- Medicare billing disputes
- Medicaid reimbursement claims
- Private insurance billing practices
- False statements in patient records
- Kickback arrangements
- Unnecessary medical procedures
- Prescription fraud accusations
- Durable medical equipment billing issues
- Telemedicine billing investigations
- Laboratory testing fraud claims
Federal agencies such as the Federal Bureau of Investigation (FBI), the Department of Health and Human Services Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) usually spearhead investigations. Prosecutors may also file related charges, including wire fraud, mail fraud, conspiracy, false statements, or anti-kickback violations.
Some cases focus on large-scale billing schemes. Others involve a smaller number of questionable claims. Anyone – from doctors and nurses to pharmacists, clinic owners, and medical billing companies – could be liable for participating in fraud schemes. Even office workers can face charges.
The good news is that many health care fraud cases involve complicated billing systems and regulations. A mistake in coding or documentation doesn’t mean that the government has a solid case against you. Federal prosecutors still must prove intent beyond a reasonable doubt before you can be convicted. Our experienced lawyers can craft and deploy tailored defense strategies that make it harder for them to meet this high bar.
Common Targets of Health Care Fraud Investigations
Federal investigators pursue many different types of health care fraud cases. Some audits and investigations focus on large organizations, while others involve solo practitioners or support staff. Common targets include:
- Physicians
- Surgeons
- Dentists
- Chiropractors
- Pharmacists
- Nurses
- Home health care providers
- Medical clinic owners
- Laboratory operators
- Medical transportation companies
- Telemedicine companies
- Durable medical equipment suppliers
- Medical billing companies
- Substance abuse treatment centers
These charges often involve:
- Billing for services that were never performed
- Inflating reimbursement claims
- Falsifying patient diagnoses
- Accepting illegal kickbacks
Some health care fraud investigations focus on prescription practices, especially when controlled substances are involved. Whistleblowers frequently contribute, as well. Under the False Claims Act, private citizens may file lawsuits on behalf of the federal government if they believe fraudulent billing practices occurred. Former employees or competitors sometimes provide information that leads to broader investigations. Prosecutors may also charge multiple people in the same investigation with conspiracy.
Even if you haven’t been charged yet, don’t talk to investigators without legal representation. Any statements you make during interviews can later be used against you in court.
What Happens After You’re Charged with Federal Health Care Fraud?
Federal criminal cases follow different procedures from state court matters. After federal prosecutors file charges, the case may proceed through several stages:
- Criminal complaint
- Indictment issued by a grand jury
- Arrest warrant
- Summons to appear in federal court
After you’re charged, you’ll typically appear before a federal magistrate judge for an initial hearing. During this proceeding, the court addresses several issues, including:
- The formal charges
- Conditions of release
- Future court dates
- Whether you’re represented by an attorney
Next comes discovery, where both sides exchange information. Federal prosecutors often demand extensive records during the discovery process. These cases may involve thousands of pages of records and complex financial analysis. Your legal team can review the discovery materials and look for problems in the government’s case. This will guide your defense strategy.
Court proceedings may involve motions to suppress evidence and arguments over whether expert testimony is appropriate. If enough key evidence is thrown out, the prosecution may not be able to proceed with the case. At this stage, your attorney can help you determine whether negotiating a plea deal for reduced charges or a more lenient sentence would benefit you.
If the case continues to trial, your health care fraud attorney will attack the prosecution’s case and may present favorable evidence for your side. The last stage is sentencing, where a skilled federal defense lawyer can advocate for better terms under the strict U.S. Sentencing Guidelines. However, some people also face civil lawsuits or administrative enforcement actions connected to the same allegations.
Penalties for Federal Health Care Fraud
Federal health care fraud convictions can come with up to 10 years in federal prison. If the alleged fraud resulted in serious bodily injury, the maximum sentence increases to 20 years. Cases involving death may carry potential life imprisonment. You could also face:
- Significant fines
- Restitution payments
- Asset forfeiture
- Supervised release
- Exclusion from Medicare or Medicaid participation
- Professional licensing and reputation consequences
Sentencing outcomes aren’t guaranteed, though. Prosecutors may argue for higher sentencing ranges based on:
- Value of financial losses
- Number of victims
- Sophisticated billing practices
- Abuse of professional trust
- Leadership allegations
- Obstruction accusations
Your defense lawyer can counter those arguments and present mitigating evidence to support a lower range.
Defenses in Federal Health Care Fraud Cases
Every federal health care fraud case involves different facts and legal issues. The federal government must prove that you knowingly and willfully participated in fraud. Mistakes and misunderstandings can be a strong defense.
However, your specific defense strategy could involve multiple angles. For example, our health care fraud defense attorneys frequently rely on:
- Lack of intent
- Billing or coding mistakes
- Insufficient evidence
- Reliance on staff or third-party billing companies
- Inaccurate government calculations
- Legitimate medical necessity
- Violations involving searches or seizures
- Unreliable witness testimony
- Misunderstanding complex regulations
Sometimes these cases involve procedural matters instead of fact-based defenses. We may challenge:
- Search warrants
- Subpoenas
- Electronic evidence collection
- Witness credibility
- Financial loss calculations
- Expert testimony
- Government interview methods
Federal investigators often rely on cooperating witnesses or former employees, which provides another chance to poke holes in the government’s case. Those witnesses may have personal motives or agreements with prosecutors that affect their credibility.
Our defense lawyers also frequently work with forensic accountants, billing professionals, and medical experts to attack the government’s claims. This independent analysis can help us find weaknesses in the prosecution’s theory and flaws in financial calculations.
Remember, federal prosecutors have the burden of proof throughout the case. Your attorney’s job is challenging unsupported conclusions and protecting your rights during every stage of the proceedings.
Why Work with the Law Offices of Jonathan F. Marshall?
Federal health care fraud investigations require careful preparation. The Law Offices of Jonathan F. Marshall has assembled a team focused entirely on criminal defense, in both state and federal courts. Our attorneys have more than 250 years of combined experience defending against criminal charges, including former county prosecutors who served in major crimes, trial divisions, juvenile divisions, economic crimes, gun task forces, and drug task forces.
Clients choose the Law Offices of Jonathan F. Marshall to benefit from:
- Free consultations
- A team of 20 lawyers dedicated exclusively to criminal defense
- 18 office locations across New Jersey
- Former municipal prosecutors from more than 25 New Jersey towns
- Familiarity with federal courts and prosecutors throughout New Jersey
Our attorneys will explain court procedures and discuss your legal options so you can make informed decisions about your defense. Then, we’ll prepare aggressive defense strategies tailored to the facts of your case, drawing on our deep knowledge of federal health care fraud laws.
We’re committed to defending clients accused of serious offenses. To see that dedication, you can review prior outcomes on our case results page, including fraud cases,* as well as the testimonials we’ve received from those we have helped, such as this one:
“I hired Jonathan and his firm to defend my son’s criminal case. Other attorneys had painted a very negative picture about the likelihood of his going to jail for a long time. Jonathan clearly knew his way around the court system. It was very comforting to see how well respected and known he was to both the judge and prosecutor… I would never think of going to another lawyer after our experience with Jonathan. I highly recommend his services.” – from our client Phil
Our Federal Criminal Defense Attorneys Are Ready to Help
Federal health care fraud charges can be complicated and aggressive. Fortunately, the Law Offices of Jonathan F. Marshall represents clients in federal criminal matters, including health care fraud defense cases. Our attorneys understand the federal court system and how to protect your rights throughout the entire process.
We offer free consultations to review the charges and explain your legal options. Contact us today and get our experienced federal health care fraud lawyers on your side.
*Each case is unique, and past results do not guarantee future outcomes.
