Healthcare Fraud

Fraud is a serious offense both at the state and federal level, and in the case of healthcare fraud, you can be charged both under state and federal law. Since this is an offense that healthcare professionals are likely to be accused of, it’s imperative to work with an experienced law firm to fight against the charges and protect your profession. The Law Offices of Martin Hart provides legal defense services to people who are charged with healthcare fraud in Las Vegas, Nevada. We work with clients to establish the offense’s circumstances and formulate a defense strategy to fight these charges.

Overview and Definition of Healthcare Fraud

Healthcare fraud is a form of insurance fraud perpetrated by healthcare institutions and providers. The offense violates Nevada’s insurance fraud laws which make it a crime to:

  • Present insurance with misleading, false, or incomplete information to support the payment of a benefit under the insurance policy
  • Assisting or conspiring with another person to defraud an insurance provider

NRS 686A.2815 makes it a crime for doctors or healthcare professionals to defraud insurance companies. This occurs when a doctor or healthcare institution files for services that were not provided, double billing, or excessive billing.

Some of the common scenarios that result in healthcare fraud include:

  • A hospital charges for the services that were never provided, including surgeries, tests, office visits, or other medical procedures
  • Inflating the costs of medical services provided to a patient
  • Filing duplicate claims (charging twice for a service that was provided once)
  • Falsifying patient records to show that they received a service that was never rendered
  • Using unnecessary devices and drugs in exchange for kickbacks from pharmaceutical or medical device companies
  • Unbundling services to receive more than was charged

Medical professionals such as dentists, therapists, nurses, medical equipment suppliers, drug researchers, medical support staff, and physician assistants often find themselves facing charges of healthcare fraud.

The elements of healthcare fraud in Nevada include:

  • You presented a claim for benefits under a healthcare insurance policy yet concealed facts or provided misleading information on the claim. If this information is submitted to a federal agency, you will face federal charges for the offense.
  • You assisted or conspired with another person to present a false or misleading statement to an insurance provider to obtain a benefit from the insurance provider
  • You acted with an intent to defraud the insurance provider and receive the benefits under the policy
  • You are a medical practitioner who encouraged another person to defraud an insurance provider
  • You solicited or accepted referral fees
  • You accepted money or benefits from an insurance provider following a false or misleading statement
  • You employed a person to find patients so that you could engage in any form of healthcare fraud
  • You participated, conspired with, or allowed an employee to make a fraudulent claim and obtain benefits from a healthcare insurance provider

Penalties and Sentencing

Healthcare fraud is a class D felony in Nevada. If found guilty, the penalties include:

  • Between 1 and 4 years in Nevada state prison
  • A maximum fine of $5000
  • Restitution to the insurance company
  • Payment of costs the state incurred in investigating and prosecuting the offense

Depending on the case, the court may suspend or revoke your professional license, effectively denying you a source of income.

Therefore, you must contact a fraud defense attorney as soon as possible to fight the charges you are facing.

If you are an immigrant, healthcare fraud is one of the offenses that could result in deportation. It is considered an aggravated felony.

The risk of deportation raises the stakes in your case, making it more vital for you to work with a skilled fraud defense lawyer who can present a solid defense to get your case dismissed or reduced to a non-deportable offense.

Nevada allows those charged with healthcare fraud to have their records sealed five years after the case is closed. However, if the charges were dismissed or you were acquitted at trial, you can seal your records immediately.

Possible Legal Defenses

Fraud offenses typically attract a lot of attention and stiff penalties for the defendants. These charges can effectively end your career as a healthcare professional as you could lose your professional license.

Working with a fraud defense attorney is one of the best ways to fight these charges and give yourself a shot at saving your career. Your legal defense team could see your charges reduced to a lesser offense, resulting in lower penalties, dismissal, or acquittal.

Some of the defenses against healthcare fraud in Nevada include:

     1. No Intention to Defraud

Intent is a critical element of healthcare fraud in Nevada. The prosecution has to prove that you intentionally filled a fraudulent claim to an insurance claim to obtain the benefits or payout.

However, if you can prove that the actions were a mistake or a result of an unnoticed error, you cannot be charged with healthcare fraud.

The healthcare system is awash with bureaucracy which could see changes taking a long time to be made. This could, for instance, result in a scenario where the billing department doesn’t realize that new and cheaper procedures have been implemented. Therefore, they continue to charge based on the older and costlier service.

     2. Police Misconduct

When citing police misconduct as a defense against healthcare fraud, your goal is to highlight some of the activities that police engaged in when:

  • Arresting you
  • Questioning you for the offense
  • Collecting evidence, and
  • Conducting a search

For instance, if the arrest was unlawful, it starts the prosecution’s case on the wrong foot, making it likely that the case would be thrown out due to disregard for the proper procedures. In other cases, the police could coerce a confession from the defendant without following due process.

Failure of police to act according to the stated procedures for conducting searches, collecting evidence, questioning suspects, and preserving evidence, corrupts the justice process.

Your fraud defense attorney will investigate your interactions with law enforcement officers throughout each stage of the criminal process to identify whether any regulations were ignored that could result in a conviction.

They will then file the appropriate motions to dismiss the evidence gathered through unlawful means. For instance, if an officer carried evidence without a search warrant or exceeded the scope of the search warrant, the court might order the dismissal of that evidence from the case.

When such evidence is suppressed and the prosecution cannot prove your guilt beyond a reasonable doubt, it becomes harder to convict you of healthcare fraud. 

Federal Healthcare Fraud

Healthcare fraud is a severe offense committed against healthcare providers. While the penalties for federal healthcare fraud are steeper than those a defendant is likely to face in state court, they are much easier to prosecute as the federal government does not require proof that you intended to defraud the insurance provider.

You are likely to be charged with healthcare fraud under federal law if you defraud national healthcare insurance providers like Medicaid.

The elements of healthcare fraud under federal law include:

  • Falsifying or concealing material facts or making fictitious and fraudulent statements or representations
  • Make or use any written material knowing it contains misleading, fraudulent, false, or fictitious information
  • In connection to the provision or payment for healthcare services, items, or benefits

Federal healthcare fraud violates several federal healthcare regulations, including:

  • Medicare fraud
  • Medicaid fraud
  • Medical billing fraud
  • Federal Health Insurance fraud
  • Anti-Kickback laws
  • False Claims act
  • Stark law
  • Controlled substances act

As with most federal crimes, federal law enforcement agencies like the FBI are responsible for investigating the offense. In most cases, your facility will not be aware of the reason for the investigation, which can complicate defending your facility. This uncertainty makes it even more urgent that you work with an experienced attorney.

When charged under federal fraud laws, healthcare fraud attracts a sentence of up to a life sentence depending on the circumstances:

  • If the patient suffers bodily injury, the court will impose a sentence of up to 10 years
  • The sentence increases to a maximum of 20 years if the patient suffers serious bodily injury
  • If a patient dies, the offense could lead to a life sentence term

*All the offenses carry the potential of substantial fines

Under federal law, those who collaborate or conspire to commit healthcare fraud also face charges for conspiracy to commit healthcare fraud. As with healthcare fraud, healthcare fraud conspiracy has a minimum of ten years and possibly a life sentence depending on the injuries or fatalities that arise from the offense.

How Your Facility Can Handle Allegations of Healthcare Fraud?

If your healthcare facility is facing allegations of healthcare fraud, the first step is to find a criminal defense lawyer who works with healthcare facilities. Such an attorney is familiar with the nuances of healthcare fraud law and gives you a better chance of fighting the allegations against you.

Working with an attorney should always be the first step in fighting these charges; therefore, the sooner you talk to one, the better your chances of preparing a solid defense.

These attorneys will help you understand what charges you are facing, why these charges were filed, and, more importantly, whether you are being charged in state or federal court. This distinction is critical in identifying the challenges you might experience during the defense. For instance, federal law does not require proof of intent to convict you of healthcare fraud.

While most healthcare fraud cases do not go to trial, they rely on a solid defense strategy to resolve the offense. Therefore, working with a lawyer as soon as you learn that you are under investigation is the best action to take.

Work with a lawyer or law firm with expertise in handling similar offenses to what you are facing. You are free to ask for their experience before you commit to one attorney who will be in charge of preparing a solid defense strategy for you.

Healthcare Fraud and Related Offenses

     1. Forgery  

Forgery in Nevada refers to intentionally attempting to defraud another person or entity using falsified documents. Like healthcare fraud, forgery in Nevada is a class D felony that carries a sentence of up to four years in prison, a fine of up to $5000, and the requirement to pay restitution to the victim.

When prosecuting for forgery, the prosecution must prove that you passed or attempted to pass a falsified document as a genuine one; you knew it was a falsified document and had the intention to defraud.

This means that you can fight the charges with similar defenses to healthcare fraud. You can show that you did not have any intent to defraud, or you did not forge the document. Another defense that works is police misconduct.

If you do not have a prior criminal record, cooperate with the police and pay full restitution to the victim, the court can agree to a plea bargain reducing your case. Alternatively, your case could be dismissed altogether.

As with healthcare fraud, forgery is a deportable crime.

     2. Commercial Bribery

Healthcare employees could face commercial bribery charges if they make business decisions without their employer’s input in exchange for money or other benefits. Commercial bribery in Nevada is a misdemeanor that attracts a six-month jail time and a fine of $1000 at most.

You are likely to be charged with commercial bribery in relation to healthcare fraud if you were involved in a kickback scheme at your facility.

Find a Nevada Healthcare Fraud Defense Attorney Near Me

Healthcare fraud is a serious offense in Nevada. It can be charged both at the state and federal levels, making it crucial for you to obtain the best defense possible to fight these charges. In addition to being charged on federal and state levels, healthcare fraud could effectively see your facility lose its operating license, which means a loss of income. The first step in preventing this is working with an experienced law firm such as The Law Offices of Martin Hart. We work with healthcare facilities and providers facing healthcare fraud charges in Las Vegas. We develop a strong defense strategy to get you started. Schedule a free consultation with us at 702-380-4278 to discuss your case.