Ohio Health Care Fraud Defense
Columbus, Ohio Criminal Defense Lawyer Defends Clients Accused of Health Care Fraud
Bob represents health care providers accused of Medicare, Medicaid, and other types of health care fraud and related crimes, including drug trafficking and alleged overprescribing. He represents all types of health care providers, including physicians, nurses, home health workers, hospitals, executives, administrators, and individuals employed in the health care industry.
As a former assistant chief of Ohio’s Medicaid Fraud Control Unit and with 16 years of experience as a health care attorney with a large law firm, Bob has unique experience in representing health care providers accused of a crime or under investigation. He understands the problems faced by health care providers under investigation where even a criminal charge or indictment can be ruinous. He takes a proactive approach. This means he works hard to investigate a case and prepare defense with an eye towards persuading the government not to bring a criminal case or other enforcement action.
Criminal cases can have serious collateral consequences, especially for licensed professionals such as physicians and nurses. Government investigations can also lead to civil or administrative actions such as False Claims Act cases or professional licensure problems. Bob understands and appreciates the criminal, civil, and administrative consequences of a government investigation and the need to handle an investigation carefully in order to protect a client’s reputation and minimize or avoid related legal problems. Early involvement by an experienced attorney will help minimize risks and may be critical to a final successful resolution of the investigation.
What Is Health Care Fraud?
Health care fraud is a type of white collar crime that involves the misrepresentation or concealment of information in order to receive benefits or make a profit.
Health care fraud can be committed by individuals, businesses, or other organizations, and can be prosecuted in state or federal courts.
A common form of health care fraud occurs when medical providers submit bills to Medicare, Medicaid, or private health insurers for services that were never provided.
Another common form is where providers bill for a procedure that is more costly than the one performed. This is called upcoding, and occurs when a provider bills for a similar but more expensive procedure, but performs a less expensive procedure.
Examples of Health Care Fraud
Examples of health care fraud include:
- Billing for services that are not medically necessary
- Upcoding (billing for a more expensive procedure but performing a less costly one)
- Billing for medical services that were never provided
- Submitting duplicate claims for the same service when it was only performed once
- Unbundling (billing each step of a procedure as a separate procedure)
- Kickbacks (offering or accepting compensation in exchange for referrals for items or services paid for by federal and state health care programs such as Medicare and Medicaid)
- Misrepresenting dates of service
- Misrepresenting service providers (e.g. billing for a doctor when the service was performed by a nurse)
- Billing for medications that were never filled
- Overprescribing medications
- Unlawful providing and dispensing of medications
Health Care Fraud Statutes and Penalties
Health care fraud is prosecuted in state and federal courts.
In Ohio, Medicaid fraud cases are often initiated by a special grand jury that sits in Columbus and hears evidence of possible Medicaid fraud. The Ohio Attorney General investigates and prosecutes Medicaid fraud through a unit called the Medicaid Fraud Control Unit. This specialized unit consists of prosecutors and investigators who specialize in handling Medicaid fraud and related cases.
Medicaid fraud may be prosecuted under any of the following state statutes:
- Medicaid fraud (Ohio Rev. Code §2913.40)
- Theft (Ohio Rev. Code 2913.02)
- Tampering with Records (Ohio Rev. Code 2913.42)
At the federal level, health care fraud is investigated by various federal agencies including the FBI, DEA, and OIG, and prosecuted by the U.S. Attorney or the Department of Justice. Federal and state authorities often work together to investigate and prosecute health care fraud.
Health care fraud at the federal level may be prosecuted under any assortment of the following:
- Health Care Fraud (18 U.S.C. §1347)
- False Statements Relating to Health Care Matters (18 U.S.C. §1035)
- The Anti-Kickback Statute (42 U.S.C. §132a-7b(b))
If you are convicted of health care fraud you face substantial fines and penalties, including prison time, fines, restitution (repayment for any amounts that were profited), forfeiture, and probation.
Health Care Fraud Related Charges
People charged with health care fraud are often charged with additional crimes such as:
- Mail and Wire Fraud
- Money Laundering
- Theft of Government Services
- False Statements
A former prosecutor, attorney Bob Cochran has decades of experience defending people accused of all of these crimes.
Collateral Consequences of a Healthcare Fraud Conviction
A conviction for healthcare fraud can also have serious collateral consequences, especially for licensed health care professionals such as physicians and nurses. Collateral consequences may include:
- Exclusion from participation in federal and state health care programs such as Medicare and Medicaid
- Professional discipline
- Loss of hospital medical staff privileges
- Loss of a professional license
- Loss of the ability to earn a living
- Immigration problems
Civil Liability for Healthcare Fraud
In addition to criminal penalties, health care fraud can lead to significant civil or administrative liability under the False Claims Act (31 U.S.C. §§3729-3733), which imposes civil liability on people who present false claims to the government. Other civil penalty statutes include:
- The Physician Self-Referral Law (42 U.S.C. §1395nn and 42 C.F.R. §§411.350-.389)
- The Exclusion Authorities (42 U.S.C. §§1320a-7 and 42 C.F.R. pts. 1001 (OIG) and 1002 (State agencies))
- The Civil Monetary Penalties Law (42 U.S.C. §1320a-7a and 42 C.F.R. pt. 1003)
Defenses to Allegations of Healthcare Fraud
For an act to be fraudulent, it must be done intentionally. If there is no intent to defraud, there can be no fraud. If a person accidentally omitted information, submitted improper billing information, or made a payment error, there can be no fraud. Thus, mistake is one of the best defenses to allegations of health care fraud.
A common question in cases of healthcare fraud is determining who actually committed the fraud. In some cases, the person in an organization who is responsible for billing is the one who presented the false claim. This commonly occurs when the individual responsible for billing receives a share of compensation based on the total revenue of the practice. In other cases, the government can prove that the medical professional knew about the false billing and participated in it.
Because health care fraud cases are often complicated, early involvement by an experienced attorney is critical to achieving a successful resolution.
Health Care Fraud Allegation in Columbus, Ohio? Robert Cochran Law, LLC Can Help
If you are being investigated or have been charged with health care fraud, you need an experienced health care fraud defense attorney on your side.
Bob Cochran, a former prosecutor, former Assistant Ohio Attorney General, and former Assistant Chief of Ohio’s Medicaid Fraud Control Unit has the experience to defend you against allegations of health care fraud and the other criminal charges that frequently accompany them.