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  4.  → Navigating the legal landscape of healthcare fraud Part 2: what should I do if I am accused of healthcare fraud?

Navigating the legal landscape of healthcare fraud Part 2: what should I do if I am accused of healthcare fraud?

In an earlier post we discussed tips to prevent allegations of healthcare fraud, available here. Although helpful to incorporate proactive measures to reduce the risk of allegations of a violation, it is also important to know some basic strategies to consider if ever faced with such an accusation.

What if I find the violation?

If you suspect a violation has occurred, act promptly. In some situations, it is helpful to conduct an internal investigation to assess the scope of the issue. If this investigation results in concerning information, self-reporting to the authorities can mitigate potential penalties. Seeking legal counsel with expertise in healthcare law is crucial when navigating these situations.

What if I receive notification of an investigation into allegations of fraud?

Notification generally arrives in the form of a letter from an official, such as the United States Attorney’s Office. This letter will likely provide general information and inform the recipient of their rights. At this point, it is often wise to seek legal counsel.

In either situation, defenses are available and can include mistake or insufficient evidence. In some cases, a safe harbor may apply which basically means that what may otherwise appear to be a violation falls within an exception. Even those who initially face a conviction can win on appeal or, as was highlighted in a recent case, a motion to acquit. In that example, upon review the judge agreed with the defense team’s argument and overturned a jury’s verdict against an emergency department physician.

Healthcare fraud is a serious offense with grave consequences. Had the physician noted above not found success with the motion to acquit he was facing sentencing for up to ten years imprisonment for the alleged violation. Although the allegations can come with criminal charges, it is generally wise to seek legal counsel with experience in healthcare law, not just criminal defense. This distinction can help to better ensure you find legal counsel experienced to handle the unique aspects of these types of charges while also remaining aware of the potential impact on your medical license.

Attorney John Rivas is responsible for this communication.