Allegations of healthcare fraud can have serious consequences. Physicians and nurses can face a threat to their professional licensure as well as potential criminal penalties. Anyone that finds themselves facing allegations of healthcare fraud will likely have many questions. It is beneficial for those in this situation to have a basic understanding of how the process works. One of the early stages in the process that you should become familiar with is the indictment.
What is an indictment?
An indictment is a formal accusation that a person has committed a crime. Our system generally uses indictments for serious criminal offenses. The process generally moves forward as follows:
- Investigation: Officials investigate the allegations. This may involve gathering evidence, interviewing witnesses, and other investigative activities.
- Grand jury: In many jurisdictions, a grand jury reviews the evidence presented by the prosecutor. The grand jury is a group of citizens who decide if there is enough evidence to charge someone with a crime.
- Presentation of evidence: The prosecutor presents evidence to the grand jury. This can include witness testimony, documents, and other relevant information.
- Deliberation: The grand jury deliberates in private to decide whether the evidence is sufficient to indict the accused. The standard is usually “probable cause” to believe that a crime has been committed and that the accused committed it.
- Indictment: If the grand jury decides there is enough evidence, they issue an indictment, which is a formal charge. This does not determine guilt or innocence but allows the case to proceed to trial.
Following an indictment, the individual facing charges is officially charged in court at an arraignment, where they are required to enter a plea of guilty, not guilty, or no contest. If the individual pleads not guilty, the case moves forward to trial, where the prosecution is tasked with proving the defendant’s guilt.
It is important to note that the process can vary depending on the jurisdiction and the specific legal system in place. For example, some jurisdictions may use preliminary hearings instead of grand juries to determine whether there is enough evidence to proceed with charges.
How does this work in healthcare fraud cases?
In a recent example, a federal grand jury indicted two pharmacists for allegedly conspiring to commit healthcare fraud. During an investigation, the authorities gathered evidence to claim that between January 2017 and December 2021 the pharmacists, along with an unnamed co-conspirator, submitted false claims to Medicare and Medicaid, receiving hundreds of thousands in allegedly unlawful reimbursements.
At the arraignment, both pharmacists appeared in court to hear the charges and enter a plea. In this case, the pharmacists pleaded not guilty and their trial is set for August 11. If convicted, they face up to 10 years in prison and substantial fines.
What are the possible consequences if convicted?
Healthcare fraud carries severe legal consequences. Convictions can lead to:
- Imprisonment: Offenders may face significant prison sentences, reflecting the seriousness of the crime.
- Fines: Convicted individuals often pay substantial fines, which serve as both punishment and deterrence.
- Restitution: Courts may order restitution to repay defrauded funds to affected programs.
- Professional repercussions: Convictions can result in loss of professional licenses and exclusion from federal healthcare programs.
It is important for those who face allegations of healthcare fraud to take the matter seriously and build a defense tailored to the specifics of the allegations while also taking steps to protect their professional licensure.
Attorney John Rivas is responsible for this communication.