Nashville Medicare
Fraud Attorney

Federal criminal charges can be a frightening proposition. Medicare fraud is a complex federal charge with serious consequences. Medicare has frighteningly high rates of fraud perpetrated against it, and as a result, the government is aggressively pursuing and punishing Medicare fraud. These charges can mean fines and imprisonment, but at the very least, means a probability of losing one’s career in healthcare. If you’re facing charges or even just being investigated, you need representation that understands the law related to this area and the seriousness of the situation. At McNally Law, we realize that everything you’ve worked for may be on the line, and we use every possible measure to defend our Medicare fraud clients in Nashville, TN.

Medicare fraud is a subset of healthcare fraud. Medicare fraud costs healthcare programs in the United States billions of dollars a year. The costly schemes have become an area of focus for the FBI. Medicare fraud occurs when someone uses false pretenses, representations, or promises to defraud any healthcare benefit. Those committing fraud must knowingly do so and be attempting to execute a scheme. This differs from Medicare abuses which are actions that cause unnecessary costs to the Medicare program but lacks the intent present in fraud. Any healthcare provider may be a defendant in a Medicare fraud case. Hospitals, doctors, nurses, physical therapists, and clinics have all been defendants.

It’s important to recognize that fraud is an intentional attempt to extract extra funds from Medicare. As such, Medicare fraud could come in seemingly endless forms; however, some schemes are more common than others. These include:

• Using slightly modified bills to charge Medicare twice for the same services
• Deliberately overcharging medical suppliers
• Offering an incentive to patients to incentivize them to participate in a scheme to defraud Medicare
• Billing for unnecessary treatments and services
• Not providing certain services and billing for them anyways
• Seeking greater reimbursement than is allowed through upcoding patient billing
• Taking services that are typically bundled together and offered at a lower price and unbundling them to receive greater reimbursement

The exact penalties for Medicare fraud depend on a number of different factors, including the unique nature of the scheme and the exact statute that the fraud is being penalized under. The three most common statutes carry the following penalties:

• The Healthcare Fraud Statute carries a penalty of fines and up to ten years in prison. Although Medicare fraud very rarely leads to bodily harm, it should be noted that if it does, there may be a prison term of over twenty years, and if it results in death, the penalty could be life in prison.
• A False Claims Act conviction can lead to a fine and up to five years in prison.
• The Anti-Kickback Statute has both a misdemeanor and felony option. The misdemeanor could involve a fine of up to $20,000 and up to one year in prison. A felony conviction can result in a fine of up to $100,000 and imprisonment of up to ten years.

In addition to those penalties, there is also the possibility of civil charges in many cases, which could mean having to repay the government up to three times the costs incurred.

The legal consequences of a Medicare fraud conviction are significant enough on their own; however, the extralegal consequences can sometimes be even more significant. For instance, one of the consequences is often the loss of a medical license. For many individuals, a medical license is the culmination of years and years of work. It’s something planned on making use of to give them a reliable, well-paying career. With the loss of that license as a result of a Medicare fraud conviction, all that can disappear. For those convicted of Medicare fraud, it can be very difficult to find a job in healthcare again.

Even outside of healthcare, the conviction can cause difficulty. The conviction creates a permanent criminal record that will appear on background checks. This can make it difficult to do things like find employment, find a place to rent, and or get a line of credit. As you can see, the consequences, both legal and extralegal, of Medicare fraud are substantial and can completely alter a person’s life. It’s important to work with a skilled defense attorney who can put up a formidable defense against these outcomes. That’s something you can count on McNally Law to do.

Medicare fraud defense can be an extremely complex process. A good defense attorney will delve deeply into an investigation of the case and related case law. From there, they can craft a defense that addresses the specifics of the fraud you may be accused of perpetrating. It’s important to remember that the burden of proof is on the prosecution. So it is not incumbent upon the defense to prove innocence but rather cast a reasonable doubt on the prosecution’s case. In many situations, this is likely to focus on the element of intent. Proving an individual’s motivations can be a difficult thing to do. The more a particular act of fraud is repeated, it may end up being harder to argue for a lack of intent. However, if the otherwise fraudulent scheme was simply something the defendant thought was a part of standard protocol, then they may be able to beat the charges. However, that may not be an available defense in all circumstances, and it would be most optimal to let a skilled criminal defense lawyer examine your case.

Medicare fraud is no small matter. The charges are serious, and the consequences can be severe. Fraud of any sort, healthcare, and Medicare more particularly, can be an especially technical and complex part of law. If you’re facing these kinds of charges, then you want a lawyer who is able to have a firm grasp on those technical aspects and who can find creative defenses against the charges. They will also need to make the technical understandable for the jury so that they can recognize why a “not guilty” verdict is the option they should choose. At McNally Law, we can bring both skill and experience to your case. We will explore every means possible to put together a formidable defense on your behalf. Contact us today to discuss your case.