FAQ — Frequently Asked Questions
The law does not technically recognize a category of crimes called “white collar crimes”; however, they are commonly understood to refer to crimes that involve the abuse of a position of trust for financial gain, and crimes that typically do not involve physical violence in the commission of the crime.
White collar crimes are typically financial crimes committed by someone who has authority over someone else’s finances. Examples include:
- Bank fraud
- Health care fraud
- Mortgage fraud
- Insurance fraud
- Ponzi schemes
- RICO crimes
- Tax evasion
- Theft in office
- Accounting fraud
- Check fraud
- Insider trading
White collar crime is punished just like any other criminal offense and may include significant fines and jail time. Sentences for white collar criminal convictions often include restitution, or paying back the ill-gotten financial gains. They also carry significant collateral consequences, such as tax liability, suspension or loss of a professional license, and suspension or debarment from participating in federally funded programs. Health care providers or individuals employed in the health care industry can lose their ability to receive reimbursement from state and federal health care programs such as Medicare and Medicaid, a process known as “exclusion.”
Some people have the mistaken belief that if they talk to the police officer, the prosecutor, or the investigating agent that they can persuade them of their innocence.
That’s simply not the case.
If you are under investigation for a crime, tell the law enforcement officer that you are invoking your right to remain silent, and that you want to speak to an attorney. Then hire an experienced criminal defense lawyer as quickly as possible.
Other times, people are worried that hiring a lawyer makes they “appear” guilty.
Prosecutors and other law enforcement agents understand that someone accused of a crime wants to speak to a lawyer when they have been notified that they are under investigation. It is your right, and it cannot be held against you.
If you believe you under investigation for a crime, or if you have been charged with a crime, hire an experienced criminal defense lawyer as soon as possible.
If you believe you are under investigation, hire a criminal defense lawyer as early in the investigation as possible.
If you are under investigation for a crime, there is a chance that law enforcement still hasn’t decided whether you are guilty and whether or not to bring charges. A skilled criminal defense lawyer may be able to convince the law enforcement agent not to bring charges, or may be able to negotiate a deal that would involve less serious charges in exchange for your cooperation.
If you have been charged with a crime, you need an experienced criminal defense lawyer on your side as soon as possible. Early intervention by a criminal defense lawyer can be a critical factor in successfully resolving your case.
For health care providers, the most serious collateral consequence of a conviction for health care fraud is likely to be “exclusion.” In this context, exclusion means that the health care provider can no longer participate as a provider in federal and state health care programs such as Medicare and Medicaid.
Exclusion refers to an administrative action undertaken by the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services. OIG has the authority to exclude individuals and entities from participation in government health care programs when those people or entities have engaged in prohibited conduct.
Exclusion means that Medicare, Medicaid, and other government health programs will cease making payments for items or services provided or ordered by the excluded practitioner. This applies even if the provider does not directly provide patient care.
For certain criminal convictions, known as “mandatory exclusions”, OIG is required to exclude an individual for at least 5 years.
Mandatory exclusions include:
- Conviction related to the delivery or an item or service under Medicare or Medicaid
- Convictions related to patient abuse or neglect in connect with the delivery of a health care service or item
- Felony conviction relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other misconduct in connection with the delivery of health care items or services
- Felony conviction relating to controlled substances
OIG also has the discretion to exclude individuals for certain other types of criminal offenses, including misdemeanor convictions relating to controlled substances. These are known as “permissive exclusions.” There are at least 16 grounds for permissive exclusions, and not all relate to a criminal conviction.
The following criminal convictions can give rise to a permissive exclusion of a minimum of 3 years:
- Misdemeanor convictions relating to health care fraud
- Fraud conviction related to non-health care programs financed by federal, state, or local government agencies
- Convictions relating to obstruction of a health care fraud investigation
- Misdemeanor convictions related to controlled substances
As a health care provider, you may have received a letter from the Ohio Department of Medicaid advising you that your Medicaid provider agreement has been suspended based upon a “credible allegation of fraud.” This means that Ohio Medicaid received allegations of fraud and, based upon a review of the allegations, facts, and evidence, considers them to be reliable.
A “credible allegation of fraud” means that someone has alleged that a health care provider has committed fraud. Allegations of fraud may come from fraud hotline complaints, claims data mining, patterns identified through provider audits, civil false claims cases, or law enforcement investigations.
If you receive a letter notifying you that your Medicaid provider agreement has been suspended based upon a credible allegation of fraud, you will be prohibited from arranging for, rendering, or ordering services for Medicaid patients during the period of suspension.
Even if you do not treat a lot of Medicaid patients, or any at all, a Medicaid suspension will pose major problems. Other insurance carriers such as private payers or Medicare may take adverse action against you. The suspension may have to be reported to licensing boards. A related investigation by the Ohio Attorney General or other law enforcement will likely be underway, or will be soon. There is also a small window for requesting reconsideration of the suspension, so you need to act quickly.
Contact an experienced health care fraud attorney as quickly as possible.