An Early, Proactive Response to a Medicare Fraud Investigation is Your Best Hope for a Good Outcome
The first question a Medicare fraud defense lawyer usually gets from a new client is: Will I go to prison? The answer depends on the nature of the alleged fraud, how early the client retains experienced defense counsel, and how they respond to the fraud investigation.
Retaining an experienced Medicare fraud defense lawyer early in an investigation gives you a number of advantages. The government has not yet charged you with a crime or obtained an indictment. Prosecutors and fraud investigators may still be willing to consider alternatives to criminal charges, or may be convinced to limit the charges to less serious offenses without a prison sentence.
For example, take the case of the OB/GYN who was accused of stealing more than $8 million from Medicare and Medicaid by billing for treatments provided by an unlicensed and often unsupervised staff. By retaining defense counsel early in the process, this physician was able to enter into a deferred prosecution agreement and avoid criminal prosecution. Under the agreement, the physician will pay back the money at issue and will retain an independent billing monitor for his practice. As long as the physician complies with these conditions for a period of two years, the government agrees not to prosecute him criminally.
In another case, a hospital in New York agreed to pay more than $1.5 million in restitution for allegedly billing Medicare and Medicaid for services that were not medically necessary or not properly documented. This case was settled as a purely civil matter with no criminal charges because the hospital retained experienced defense counsel, approached fraud investigators very early in the process, and negotiated a resolution.
In contrast, every day the government announces lengthy prison sentences for healthcare providers who are accused of frauds involving much less money. Consider, for example, the chiropractor who was recently sentenced to 44 months (more than three and a half years) in prison and another three years of supervised release for allegedly submitting less than $200,000 in false insurance claims.
The outcome in any case, of course, depends on a number of different factors. Prosecutors tend to be more aggressive when the alleged fraud involves risks of harm to the health and safety of patients. Prosecutors tend to be less willing to negotiate when the alleged fraud involves billing for services or products that were never actually provided, or when the alleged fraud is part of a larger criminal scheme.
Regardless of the nature of the alleged fraud, however, your best hope for a favorable outcome is retaining an experienced Medicare fraud defense lawyer as soon as you believe that you are under investigation. That is when you and your lawyer have the most options and the best chance of avoiding a personal and professional catastrophe.
John Howley, Esq.
John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York 10118
This web site provides general information. It does not provide legal advice. You should consult a lawyer to obtain legal advice regarding your personal situation.