Phoenix Healthcare Fraud Attorney

Healthcare Fraud Overview

Healthcare fraud by doctors and health providers can occur in several ways, often unintentionally, due to new terminology and coding systems, which are frequently confusing. Healthcare fraud typically occurs when doctors or other health professionals lie to insurance companies about specific medical procedures to receive more money than they deserve. 

Healthcare fraud is now a federal criminal offense, punishable by up to 10 years, due to the Health Insurance Portability and Accountability Act of 1996.

Healthcare fraud can include:

• Prescription drug fraud: This involves acquiring prescription medicines through fraudulent means to either use or distribute them illegally. Practices include doctor shopping, prescription forgery, and illegal online pharmacies.
• Medical services fraud: This fraud includes billing for services not rendered, upcoding charges to increase reimbursements, and performing unnecessary procedures to bill for higher fees.
• Insurance fraud: Involves submitting false claims for procedures not performed or exaggerating the severity of injuries to receive undue insurance benefits.

Agencies Involved in Combating Healthcare Fraud

The investigation of healthcare fraud is typically a joint effort involving state and federal agencies, including:

• The Federal Bureau of Investigation (FBI)
• The Department of Health and Human Services (HHS)
• The Office of the Inspector General (OIG)
• State-level Departments of Insurance

Healthcare Fraud Conviction Penalties

Healthcare fraud penalties are severe and may include hefty fines, restitution (paying back the defrauded amount), and imprisonment. At the federal level, convictions can result in up to a decade in prison for each count, and if the fraud results in serious bodily injury, the sentence can increase by up to 20 years. 

In addition to criminal penalties, individuals may face civil penalties, including fines of up to $50,000 per violation and an assessment of up to three times the amount of damages sustained by the government.

Conviction of healthcare fraud can have devastating and long-lasting effects on your professional career. In addition to the legal penalties, you can face career-ending repercussions, including the state medical boards' revocation or suspension of your license. 

Furthermore, you are typically excluded from participation in federal healthcare programs such as Medicare and Medicaid, limiting your employment opportunities within the healthcare sector. The stigma associated with a fraud conviction can make it exceedingly difficult to regain professional standing and continue a career.

The Value of Criminal Defense Representation

Facing charges of healthcare fraud demands experienced legal representation, especially given the complexity of healthcare laws and the involvement of state and federal agencies. A skilled criminal defense attorney can provide crucial guidance, challenge the prosecution's evidence, negotiate plea deals, and advocate for lesser penalties or alternative sentencing options.

At Ryan Garvey Attorneys, PLC, you can seek help from a former prosecutor with 25 years of professional experience. Mr. Garvey stays current with evolving regulations and case law in healthcare and has a proven track record of successfully defending clients. 

We understand the high stakes in fraud allegations and are committed to achieving the best possible outcome, safeguarding your professional license, reputation, and freedom. You can trust our experience, aggressive stance, and results-driven approach when guiding you through challenging times.

Schedule a confidential consultation with our Phoenix healthcare fraud defense lawyer by contacting a team member online or at (602) 353-7328.