What Are Defenses For Health Care Fraud Victims?

Fight Medical Fraud What Are Defenses For Health Care Fraud Victims?

What Are Defenses For Health Care Fraud Victims?

A healthcare accusation is an expressway to a complex and overwhelming situation. The situation is challenging to navigate, fight, and hard to get away with.

Federal prosecutors are becoming more creative with discoveries of how they can prosecute and charge healthcare fraud. To ease the burden of fighting the changes, come up with a more effective defense and ease the process, DoNotPay is here to help you with the best healthcare fraud defense.

Health care fraud is any arrangement to hike a patient's health care bill or fraud against a health care insurance program. Fraud is deceit that is intended to result in financial gain. The misinterpretation of the actual charges is usually a claim sent to an insurance company such as Medicaid or Medicare.

Once the claim is verified and submitted to an insurance company for reimbursement of the services that were either not rendered, medically unnecessary, not allowable, or overcharged, the facility or the person who caused the Medicare medical fraud can be prosecuted for fraud.

Examples of Health Care Fraud

Some of the activities that are translated to be healthcare fraud are:

  • Billing for services that the patient did not receive
  • Self-referral arrangements
  • Upcoding by charging for higher-grade services than what was offered
  • Unbundling by charging several codes to increase the refund
  • Pharmacy fraud
  • Home healthcare fraud
  • Improper coding
  • Overutilization
  • Overprescribing opiates

You need to know what possible healthcare fraud defenses institutions might use to protect themselves when you make claims against them.

The Primary Health Care Fraud Charges

Several healthcare fraud charges may be submitted in federal court, but the following are the most common ones

  1. Criminal Health Care Fraud
  2. Anti-Kickback Statute
  3. False Claims Act
  4. Stark Law – Physician Self-Referral Law
  5. Health Care Fraud Conspiracy
  6. Wire and Mail Fraud
  7. Conspiracy to Defraud the Government concerning Claims
  8. Civil Monetary Penalties Law (CMPL)

The Possible Penalties and Sentences of Health Care Fraud

The victim may face varying penalties and sentences depending on the violated statutes. If you were convicted of upcoding and unbundling conspiracy, anti-kickback, wire and mail fraud, or false claims, you might face severe fines, including

PrisonDepending on your conviction, the sentence may be from 1 year to life imprisonment.
FinesCivil and criminal fines can accumulate very fast for someone facing healthcare fraud charges. The particular sanctions will vary depending on the offenses and the facts obtained during investigations. However, the most severe criminal violation may lead to a $1,000,000 fine, while some penalties may be applied on the claim or per-service basis. Sometimes, the fines may include lawyer fees or three times what the government's program loses through the case.
RestitutionYou may be asked to repay payments received illegitimately through malicious activities under the Stark Law.
Loss of DEA Registration or Medical LicenseViolating Anti-kickback Statutes or convictions for health care or Medicare fraud can result in losing your DEA registration or medical license.
Loss of Medicare or Medicaid Program ParticipationIf you are convicted of health care fraud, you can be banned from participating in federal Medicare or Medicaid programs.
Asset Seizure and Criminal ForfeitureDOJ, FBI, or DEA can grab your property while investigating your case and you might lose ownership under criminal forfeiture.

The Possible Defenses for Health Care Fraud

After the penalties and sentences, you may decide to defend yourself from the charge in the following ways

  • Insufficient Evidence
  • Compliance Program
  • Lack of Intent or Mistake
  • Stark Law Exceptions
  • Anti-Kickback Statute Safe Harbors
  • Voluntary Disclosure

Let DoNotPay Pursue Health Care Fraud Defense on Your Behalf

Defending yourself after being convicted of health care fraud is challenging and overwhelming. Thankfully, DoNotPay can help you through the process and offer successful results.

All you should do is the following

  1. Search Fight Medical Fraud on DoNotPay.


  2. Tell us the date of your visit, what you were treated for, and where you were treated.


  3. Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code.


  4. Choose the correct CPT code or let us know if you want us to find it for you.


  5. And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction.


And that’s it! DoNotPay will do the grunt work of searching the numerous codes that your medical provider used and check for upcoding and unbundling or fraud. DoNotPay will even write the demand letter that you can use to make demands from your physician or report medicare fraud.

Why Use DoNotPay for Health Care Fraud Defense?

Reporting medical billing fraud or even just spotting them can be tricky. Whenever you use DoNotPay for your matters, you are sure of the following benefits

  • DoNotPay is easy to use. Whether you use the mobile app or web browser, you will genuinely escape the tedious processes that frustrate you. Your issue will be handled within a few clicks.
  • DoNotPay is fast. You will not wait forever to see the results.
  • DoNotPay is convenient. You can access all services in the comfort of your home, anywhere and anytime.

DoNotPay Can Help You with Other Personal Issues

While all you may need from DoNotPay, for now, is healthcare fraud defense, there are many other ways we can help you. DoNotPay’s online browser or mobile app will guide you on our many features and the numerous services we offer in an easy, affordable, and convenient way. Some top services are

No matter the situation you are facing now, DoNotPay is here to help you. Join DoNotPay today for all your personal needs, and DoNotPay will deliver successful results!

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