DC Federal Healthcare Fraud Lawyer

In order to receive funding from various government and private sources, healthcare providers are required to file claims that detail the services provided to patients, as well as information regarding the payments requested.

Those who believe they are under investigation or who have been charged with healthcare fraud should consult with an experienced attorney who is well versed in federal law. A DC federal healthcare fraud lawyer has strong grasp of the DC court system that can give you peace of mind when heading to trial.

What is Prescription Fraud?

Prescription fraud is the acquisition of prescription drugs obtained illegally for personal use or profit. Sometimes, prescription fraud involves the accusation that a pharmacist or the owner of a pharmacy issued prescriptions for drugs such as painkillers they should not be administering to get more money from them. Sometimes, a patient is alleged to be writing false prescriptions from a stolen prescription pad or by other means and is selling the drugs they allegedly received.

More information:

Types of Healthcare Fraud

Healthcare fraud cases are not limited to fraud against the government, and can also involve fraudulent schemes targeting private insurers. There are many types of alleged behavior that can result in a healthcare fraud case, including the following:

  • False claims made to Medicare
  • False claims made to Medicaid
  • Overbilling for services
  • Unbundling
  • Upcoding
  • Billing for one service while performing another
  • Billing for name brand drugs while giving patients generics
  • Billing for services never provided
  • Kickbacks
  • Billing for medical equipment or supplies that were never purchased

As there are a number of kinds of healthcare fraud, there are several laws under which alleged fraud can be prosecuted. Some of the more common include the following:

Understanding the False Claims Act

The False Claims Act originated during the civil war, in a period when the government was subjected to massive fraud from contractors providing poor quality or unusable military supplies. The law imposes liability on people or parties who defraud the federal government, and also contains a qui tam provision allowing private citizens to join with the government as whistleblowers by calling attention to fraudulent behavior. Known as “relators,” these individuals can recover up to 30 percent of the total amount recovered by the government in qui tam actions.

Prosecutor Treatment of Health Care Fraud

As a DC federal healthcare fraud lawyer knows, prosecutors intensively pursue healthcare fraud cases because millions of dollars may be at stake. Sometimes with prescription fraud, there is an activation of a stream of painkillers going out into the public without proper control that could be devastating because people could overdose on the painkillers. The case is treated seriously in court when a person commits that type of offense.

Examples of Healthcare Fraud Offenses

When an individual is charged with this type of health care fraud, whether they are a pharmacist or the owner of a pharmacy, they are usually charged with some sort of manipulation of the issuing of prescriptions.

It might be that a vendor in a pharmacy is charged with distributing prescription medication such as painkillers to people who are not supposed to have them and they are making money off that.

A customer might obtain a doctor’s prescription pad and write a false prescription for themselves to obtain drugs such as painkillers. A doctor may prescribe painkillers to people who do not need them and receive a kickback in exchange for the prescription.

Healthcare Fraud Allegations

Healthcare fraud allegations can involve serious legal and professional consequences, some of which could have a lasting effect on one’s career and practice.

Because of the complicated nature of many of these federal laws, healthcare fraud charges may be, and often are, brought against people who were only tangentially involved in alleged fraudulent activity.

Often times those investigated and charged with such crimes were not fully aware such activity was taking place. Having a DC federal healthcare fraud lawyer evaluate your culpability may help defeat such charges or mitigate against any potential penalties.