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Why do I need a lawyer if accused of healthcare fraud?

On Behalf of | Feb 16, 2023 | Home Health Agencies |

Allegations of healthcare fraud can lead to serious penalties. Those who face these allegations are often highly intelligent people like physicians and chief executives of healthcare facilities. As a result, it is not a surprise that these individuals often think they can handle the allegations and move on with their lives.

But a word of caution, a failure to take the allegations seriously and fight back can result in surprising consequences.

What kind of surprises?

What starts as allegations of healthcare fraud is often just the beginning. Prosecutors will explore all avenues during the investigation and could find evidence to pursue other criminal charges, like wire fraud, money laundering or tax crimes.

These criminal allegations are also likely to trigger a state board investigation or, for those who do not have a professional license like a physician, can make it difficult for an entrepreneur to get a license to open certain healthcare facilities like a home healthcare business.

Does this really happen?

Unfortunately, this is not just a discussion of possibilities. In a recent case, the feds were alerted to allegations of healthcare fraud within a New York home healthcare facility. The investigation focused on claims for payment from government services like Medicare and Medicaid. Officials claim to have found evidence the owner of the facility filed claims for tens of millions for services never provided.

The prosecution gathered enough evidence to move forward with criminal healthcare fraud charges and began negotiations with the accused. When faced with the allegations, evidence, and many potential criminal charges the accused chose to plead guilty to wire fraud charges.

Although the owner likely faced a number of charges, even this one conviction translated to harsh penalties. In addition to mandatory restitution of over $1.5 million, the court also sentenced the owner to 54 months imprisonment.

The criminal conviction will also result in scrutiny by state agencies like the New York Department of Health making it difficult for the owner to get the licenses needed to operate in this industry in the future. The same type of conviction would also likely trigger an investigation by a state board if the individual had a medical or nursing license — potentially putting their license to continue to practice in their chosen field at risk.

What if I face similar allegations?

It is important to have legal counsel on your side to build a defense, guide negotiations, and help to better ensure you understand the full ramifications of any potential plea deal before accepting an offer from the prosecution.

Attorney John Rivas is responsible for this communication




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