A New York City Defense Attorney Explains Consequences of Medically Unnecessary Services Fraud
A cancer doctor was recently sentenced to 45 years of imprisonment for giving cancer treatment drugs to patients who did not need the medications. CNN reports the doctor also forfeited $17.6 million in improper payments he received from insurance providers. More than 553 patients had received medically unnecessary services, and the patients or their insurers paid the bills for this treatment.
This case was one of the most significant fraud cases in recent years, and it resulted in very harsh penalties. However, there are many cases in which defendants are charged with criminal wrongdoing because they are accused of medically unnecessary services fraud. If you are accused of providing and/or billing for services that patients did not require, you need to make sure you respond assertively and aggressively to accusations and that you develop an effective strategy for defending yourself against all of the potential legal charges that could result from the serious claims being made against you.
Bukh Law Firm, PLLC is a New York based criminal defense firm with extensive experience in healthcare fraud cases and health insurance fraud cases. Our legal defense team is ready to help you develop a strategic response to civil and criminal actions, with the goal of avoiding consequences for alleged wrongdoing or negotiating the most favorable pleas possible so the minimal penalties can be faced. Call now to learn more.
What is Medically Unnecessary Services Fraud?
Medically unnecessary services fraud refers to providing and/or billing for medical services a patient does not actually need. The goal is to make money for providers. Patients can be offered services which have no benefit to them at all, or can be given medical services which are more expensive than the procedures which would normally be recommended based on their health status. Patients can also be provided with medical equipment despite there being no legitimate need for it, or can be charged for lab tests that would not normally be necessary.
Medically unnecessary services fraud crimes can also involve the payment of kickbacks. It is illegal to offer, solicit, pay, or accept money or other benefits in exchange for the referral of patients for services. Other related crimes can include money laundering, mail or wire fraud, and a variety of other federal and state offenses in connection with the provision of medically unnecessary services.
Penalties for Medically Unnecessary Services Fraud
The cancer doctor who was sentenced to imprisonment for providing medically unnecessary services was charged for various crimes including health care fraud, money laundering, and conspiracy to pay and receive kickbacks. Although patients had accused him of committing murder and poisoning them, prosecutors believed it was easier to make a case based on fraud allegations rather than specifically going after the doctor for the alleged harm he had done to the lives of patients.
There are a wide variety of federal and state laws which impose prison terms on people who make false statements to secure benefits or payment from Medicare or government health insurers; as well as federal and state laws which impose penalties on providers who defraud private health insurers. While each individual statute generally carries a maximum penalty of between five and 10 years imprisonment, depending upon the specific code you are charged under, defendants can be charged for multiple counts of fraud when there are many patients or many treatments involved.
Financial consequences are also possible, in both criminal and civil cases. Qui tam lawsuits can be filed by whistle blowers, which are civil lawsuits filed under the Federal False Claims Act that allow individuals to bring fraud to light. Whistle blowers get a major financial benefit if they help the government recover money, because they can keep a part of the funds obtained as a result of their false claims lawsuit.
How a NY Health Care Fraud Defense Lawyer Can Help
You need to get help from a knowledgeable legal advocate if you’ve been accused of medically unnecessary services fraud, because these types of cases are taken very seriously. Bukh Law Firm, PLLC has experience providing representation to clients accused of state or federal offenses, and can represent you in all legal proceedings arising from allegations of fraud. Call as soon as possible to speak with a New York City health care fraud defense lawyer to learn more.
