The Criminal Defense Firm serves clients in Detroit to defend allegations of healthcare fraud. Our team assists with:
- OIG & Grand Jury Subpoenas
- Medicare & Tricare Audits
- Defending Fraud Allegations
- Internal Investigations
- Compliance Programs
- Qui Tam Defense
- Asset Protection
- Criminal Defense
- Jury Trials
If your case is an emergency, you should not hesitate to call us immediately, including on weekends. All calls are free and confidential.
Put our highly experienced team on your side
Brian J. Kuester
Former U.S. Attorney
Former DA
Amanda Marshall
Former U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney
& Former District Attorney
Local Counsel
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Linda Julin McNamara
Former Chief, DOJ Appeals
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Healthcare Fraud Investigations in Detroit
Detroit is one of only nine U.S. cities in which the federal government has established special task forces to monitor, investigate, and prosecute Medicare Fraud. Healthcare practitioners and businesses in Detroit must know that government prosecutions in Detroit are more aggressive and significantly more frequent than in other communities and spearheaded by the elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and others.
Healthcare Fraud Explained
Federal healthcare fraud describes an attempt or act to obtain money or other items of value from a government program such as Medicare, Medicaid, Tricare, or federal workers’ compensation (DOL) through false and fraudulent representations.
- Anti-Kickback Violations. Healthcare laws prohibit any form of remuneration in exchange for referrals. Any person— that includes physicians, marketers, business owners—may be subject to healthcare fraud prosecution for offering or paying monies or other valuables in return for a patient referral.
- Stark Law: Stark Law prohibits physicians to refer patients to designated health services entities, in which the physicians (or an immediate family member) have an ownership or an investment interest or with which the physician has a compensation arrangement—unless one of the statutory exceptions applies.
- False Claims Act Violations. Any time a provider submits a claim to Medicare, the federal False Claims Act applies. If the bill submitted is incorrect, even if unintentional, the statute’s harsh civil penalties kick in. In more serious cases, the government can also investigate incorrect billing schemes under the criminal provisions of the False Claims Act.
- Prescription Fraud. The government scrutinizes physician practices with unusually high volumes of narcotic prescriptions. In particular, doctors suspected of running “pill mills” may be investigated for insurance fraud and violations of DEA dispensing rules.
- Billing Fraud. The government investigates with particularity up-coding (billing code used higher than service level provided), phantom-billing (billed for services not provided), billing for ghost-patients (billed for patients that don’t exist), and billing for services that are found medically unnecessary.
- Certification Errors. The government has intensified its investigations against the home health and hospice industry. One of the main allegations is that some physicians and nurses fraudulently certify the need for medical services although the patient is either not homebound (home health) or not terminally ill (hospice care).
The Criminal Defense Firm has a long and distinct record of avoiding criminal charges. If you or your practice are under investigation, or to find out what to do next, you should speak with one of the former prosecutors and experienced defense counsel of The Criminal Defense Firm today. All calls are free and confidential.
Penalties
Healthcare fraud is a serious offense. Penalties range from civil recoupment requests, nonpayment of claims and program exclusion to criminal prosecution, fines, and even incarceration. The general criminal healthcare fraud statute at 18 U.S.C. 1347 provides:
- Up to 10 Years in Prison for Each Count of Healthcare Fraud
- Up to 20 Years in Prison If the Fraud Resulted in Serious Bodily Injury
- Life in Prison If the Fraudulent Scheme Resulted in the Patient’s Death.
What is the Worst-Case Scenario? In general, whether someone will be criminally prosecuted and will go to jail for healthcare fraud depends on several factors such as the gravity, the interest of the prosecutor to take the case, and the motivation behind the alleged fraud. What makes The Criminal Defense Firm unique in its representations in healthcare fraud cases is our dual expertise as former healthcare prosecutors and renowned defense attorneys. Our group has a long and distinct record of avoiding criminal prosecution. If you are under investigation or if you simply want to discuss your case directly with one of our experienced attorneys, you should contact The Criminal Defense Firm today. All calls are free and confidential.
When Is Healthcare Fraud Criminal?
As seen, healthcare cases can be both civil or criminal in nature. Through early intervention and sophisticated defense strategies, The Criminal Defense Firm has made a name for itself to avoid criminal charges in a great number of federal healthcare investigations. If you believe your practice is being investigated, you should speak with our experienced attorneys immediately to discuss your situation and to develop an effective defense plan.
In many healthcare investigations it is often unclear at the beginning whether the case is civil or criminal. Contrary to common belief, the U.S. Attorney’s Office is divided into a civil and a criminal division and it employs federal prosecutors that conduct civil and those that pursue criminal prosecutions. Thus, the mere fact that a prosecutor is part of a (healthcare) case is no indication per se that the case is about criminal charges. That same division between civil and criminal government lawyers applies to federal agents. Just because someone was contacted by an OIG or an FBI agent does not automatically mean that the inquiry is about a criminal case since many agents investigate civil matters. Furthermore, from our own experience as federal civil and federal criminal healthcare prosecutors, we know that cases that start as a civil investigation can turn into a criminal matter, if defended poorly.
While the determination of the case nature first often depends on skillful interpretation of, for example, the requests made in an OIG subpoena, the tone of the inquiry, or the allegations, there are still some indications that would suggest a criminal prosecution rather than a civil matter. Such signs include the execution of search warrants, seizure warrants, arrest warrants, issuance of target letters, the involvement of criminal prosecutors, the involvement of the IRS, or the issuance of grand jury subpoenas.
If you have questions, please call us directly. Our clients range from individual providers to entire healthcare systems. We represent clients in Detroit who are under investigation by the Department of Justice (DOJ), the Department of Defense (DOD), the Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), the Medicaid Fraud Control Unit, Detroit and Michigan law enforcement, or the Internal Revenue Service (IRS).
Defending Healthcare Fraud
The Criminal Defense Firm is a healthcare fraud defense law firm. Throughout our careers, we have handled over 1,000 healthcare matters and tried more than 200 criminal cases in court. Many of our attorneys were previously in charge of healthcare audits and fraud investigations at the Department of Justice and they now offer their valuable insights and extraordinary experience with our clients.
- Immediate Defense. Our number one goal in every investigation is to avoid criminal charges. Our experience and our success rate tell us that the best way to avoid criminal prosecution is not to wait and let the government build its case, but to intervene early in the case while there is still room to impact the investigation. From the moment you engage our services, you will see us working relentlessly to protect your freedom and your livelihood. Within the first hours of an engagement we are often able to answer the most pressing questions: What is the case about? What is the purpose of the investigation? How long will it take? What is the likely outcome?
- No Intent. The U.S. Constitution requires the government to prove criminal intent beyond a reasonable doubt. That’s a high standard and we put it to the test whenever the government threatens criminal charges. While prosecutors often point inaccuracies in billing records to prove a defendant’s intent, we know that innocent mistakes happen and such mistakes do not equate to fraudulent intent. The Criminal Defense Firm has successfully defended clients across the country by showing that any misinformation in their billing records resulted from organizational or human error and not from fraudulent intent. In our experience, unqualified staff, delegation and outsourcing errors, failed oversight, and insufficient supervision, on top of constantly changing healthcare and billing rules may all lead to errors, but they should not lead to criminal liability.
- Legal Defenses. Besides having the trial and negotiation skills needed to defeat a government’s case, the attorneys of The Criminal Defense Firm also have the specific healthcare law expertise to introduce applicable defenses and statutory loopholes. We have won many cases by showing how exceptions, for example in the context of the Stark Law or medical necessity certifications, apply to our clients’ case and either mitigated or eradicated the government’s fraud case.
- Protecting Your Reputation. Our commitment to defend our clients against unfounded allegations of fraud and wrongdoings goes far beyond establishing legal strategies and defense plans against government investigations. Many of our clients are equally concerned about their reputation and their perception in the public. The media has the power to ruin someone’s reputation or to ignite rumors about wrongdoings by offer biased and prejudicial news reports to its audience. Our attorneys routinely intervene into slandering reporting and obtain news spots and opportunities to correct and rectify errors by educating the audience about the truth.
The Criminal Defense Firm has appeared in healthcare proceedings across the country to help clients fight fraud charges. Call us today to discuss your situation with our experienced attorneys in a free and confidential conversation.
Our Record
The commitment of The Criminal Defense Firm is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability. - Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability. - Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
Result: No civil or criminal liability. - Representation of a Healthcare Services Company against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged False Claims Act and Stark Law Violations.
Result: No civil or criminal liability. - Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
Result: No civil or criminal liability. - Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
Result: No civil or criminal liability. - Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
Result: No civil or criminal liability. - Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability. - Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
Result: No civil or criminal liability. - Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability. - Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability. - Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
Result: No civil or criminal liability. - Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
Result: No civil or criminal liability.
Healthcare Fraud Defense Attorneys Serving Detroit
Fill out our contact form or call us today and speak to one of our experienced attorneys directly. We are available to discuss your situation in a free and confidential call, including on weekends.