Charged With Health Care Fraud? A Health Care Fraud Defense Attorney Can Provide Legal Options And An Effective Defense

Spencer & Associates | An Experienced Health Care Fraud Defense Firm in Dallas, TX

If you’re charged with health care fraud by a federal or state agency, it can have dire financial, professional and personal consequences for you and your family. Whether your alleged offense is charging for unnecessary procedures, upcoding, phantom billing or unbundling, you’re facing serious allegations that could potentially derail the course of your life, whether you are convicted or not.

To avoid or prevent the most serious outcomes, such as prison time, treble damages or loss of your medical license, you’ll need a proactive and effective legal strategy. Spencer & Associates has successfully represented clients in white-collar matters for years and understands the intricacies of the laws governing health care fraud.

Defending Against Health Care Fraud Charges: Legal Strategies That Work

It’s only natural to feel panic and confusion when you’re charged with health care fraud. The potential outcomes may seem frightening at first, but a skilled health care fraud lawyer can evaluate the facts of your case and build a strong defense strategy that may result in your charges being dismissed or reduced. They can also negotiate settlements that lessen financial and professional penalties.

Why Is Hiring An Experienced Defense Attorney Critical In Health Care Fraud Cases?

There are three important reasons why hiring an experienced and skilled health care fraud defense attorney makes sense:

• The complexities of health care fraud law. These cases are Gordian knots of federal regulations, fraud statutes, sentencing guidelines and medical billing practices with elaborate coding systems. An experienced defense attorney accustomed to handling health care fraud issues understands every aspect of this type of litigation and helps you navigate what would otherwise be an overwhelming legal landscape.
• The far-reaching consequences of a health care fraud conviction go beyond criminal penalties. In addition to your criminal defense, your health care fraud attorney also has experience handling negotiations regarding disciplinary actions from licensing boards, exclusion from federal health care programs, loss of hospital privileges and more.
• Recognizing the best strategy to achieve the optimal outcome for your case. If you believe your alleged fraud was instead an administrative error or a legitimate matter of medical judgment, your health care fraud attorney knows how to present the appropriate evidence to build a strong defense. Your attorney will also know when to seek dismissal or reduction of your charges, plea agreements or negotiated settlements that reduce financial or professional penalties.

How Can A Health Care Fraud Defense Attorney Challenge Health Care Fraud Allegations?

There are several ways your attorney can challenge the charges against you, including:

• Challenging your intent to defraud. The prosecutor in your case has the burden of proving that you willfully and knowingly participated in deceptive practices. Where appropriate, your attorney can argue that your alleged fraudulent act was in fact a matter of error, confusion, incomplete documentation or performed by a third party without your knowledge.
• Challenging the interpretation of billing data. Because medical billing is so complex and subject to varying interpretation, your attorney may call on experts, such as medical coding specialists, physicians or compliance experts, to support your interpretation over the government’s.
• Challenging medical necessity allegations. If the government charges that the treatments you authorized were not necessary, your attorney may present evidence of medical experts, the patient’s medical records or standards of accepted care that indicate the contrary.
• Challenging the evidence. Because the evidence in a health care fraud case is so vast, your attorney’s review of that evidence may uncover issues or inconsistencies involving witness credibility, faulty interpretation of records or improper assumptions made by investigators. There may also be issues of how evidence was obtained if it involved unlawful search, defective warrants, improper seizures or coercive interviews.

What Evidence Is Commonly Used In Health Care Fraud Cases In Dallas, TX?

Health care fraud cases typically involve a vast and complex array of financial, medical, electronic and testimonial evidence. Prosecutors may rely on any or all of the following forms:

• Billing records and insurance claims for charges such as upcoding, phantom billing, duplicate billing or medically unnecessary treatment
• Medical records or patient files that the prosecution believes were insufficient, falsified or modified
• Electronic health record (EHR) data, where login histories, audit trails, metadata and other digital footprints can leave behind evidence that the records were modified or tampered with
• Financial records that may indicate payments resulting from illegal referrals or improper financial relationships
• Internal communications and communications, such as emails or texts, that acknowledge or suggest knowledge of improper practices
• Testimony of whistleblowers or experts that focus on standard procedures, billing practices or medical necessity
• Audit findings and statistical samples to pinpoint and calculate fraudulent billing amounts
• Digital or paper records gathered from search warrants and seized records
• Evidence gathered from undercover operations, recorded conversations or surveillance is typically relied on in prescription fraud, kickback schemes or patient recruitment schemes.

Still Have Questions? Call Us!

Spencer & Associates is a highly regarded and reputable health care fraud defense firm serving the greater Dallas-Fort Worth area. If you’ve been implicated in a federal health care fraud investigation and are wondering what to do next, contact us today at (214) 376-4441 for a free consultation or schedule an appointment on our website.