Legal Defense for Health Care Fraud Investigations in the Houston Area
The Criminal Defense Firm provides a zealous and strategic defense to individuals, health care facilities, and businesses in New Orleans, Louisiana who have been accused of violating the False Claims Act. Our Health Care Fraud Defense Team has experience with both criminal and civil investigations. We can help you get the answers that you need to put the investigation behind you. Our attorneys are available 7 days each week. If you’re facing an investigation for fraud, don’t wait. Call The Criminal Defense Firm right away.
What You Need to Know About False Claims Act Investigations
More than 300 cases of medical fraud were brought forward in 2016 by the Department of Justice. This is an all-time historical number of people charged since the inception of the Medicare Fraud Strike Force. More than 60 doctors, nurses, and other licensed professionals were investigated. More than 200 health care facilities and related companies were investigated. The false billing totals amounted to more than $900 million.
The federal government uses the Medicare Fraud Strike Force in conjunction with the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Both are made up of investigators and prosecutors from numerous federal agencies including the FBI, the Office of the Inspector General, Department of Health and Human Service, the Department of Justice, and the Department of Defense. Although health care providers and businesses in any state are vulnerable to these charges, Louisiana is one of nine areas in the United States that receives the most scrutiny. Allegations of a violation of the False Claims Act are an extremely serious matter.
False Claims Act Basics
The False Claims Act is a federal statute that is directed toward any person or business that has either direct or indirect contracts with and is paid by the United States government. It presents a legal liability for any person, organization, corporation, or government contractor who knowingly submits or is the cause of submittal of a bogus or fraudulent claim for payment by the government.
It’s important that you understand the government’s definition of the word “knowingly.” It means that you knew or you should have known about whatever happened to cause the violation. For example, take the recent changes to ICD coding. If someone in your practice or business uses an older code that is obsolete, that may be considered a violation of the False Claims Act. This is because your organization should have performed due diligence and knew that the code had changed.
False Claim Act Violations Have Criminal & Civil Liabilities
Alleged violations of the False Claims Act can have both criminal and civil liabilities for you or your business. When the investigation begins, it may be hard for you to ascertain if it is civil or criminal in nature. The Criminal Defense Firm can help you find out the potential liabilities involved usually within days. Knowing the potential liabilities makes it easier for you or your business to correct any errors that led up to the violations.
Civil liability is ultimately determined by the civil court. You may be forced to pay three times the amount of what the government lost out on because they paid a fraudulent claim. You could also be fined up to $11,000 per claim. Criminal liability is determined by the criminal court. You could receive a five-year prison sentence and fines based on whether you’re charged with a misdemeanor or a felony under 18 USC § 287. Much like with civil liability, the fines are assessed per claim.
- Misdemeanors can be fined up to $100,000 per claim for an individual and up to $200,000 per claim for businesses.
- Felonies can be fined up to $250,000 per claim for individuals and up to $500,000 per claim for companies.
Qui Tam Lawsuit Basics
In New Orleans, most of the investigations involving a violation of the False Claims Act aren’t actually started by the federal government. They often start because of a former employee who is unhappy with your company, or they are started by a competitor who is trying to stop the success of your business. The False Claims Act provides a way for private citizens to bring about these claims in a qui tam lawsuit. The actual goal is supposed to be that of assisting the government in recovering money that they paid out on false claims. Qui tam means “he who sues for the king and himself.” In this instance, “king” is a direct reference to the federal government. However, when these claims are filed by former employees of a competitor, it’s rare that their motive is to help the federal government.
In a qui tam case, the plaintiff is referred to as a qui tam relator. They would file their case with the Eastern District of Louisiana. Complaints are sealed to protect the identity of the plaintiff. In a true whistleblowing situation, protecting the identity would be important. The only unsealed copies of the complaint made available go to the assigned judge and certain government officials. Extensions of the case could be granted until the federal government concludes its investigation.
The federal government can choose to reject an unsubstantiated qui tam lawsuit. If the government believes that there very well could be a violation of the False Claims Act, they will investigate. This could involve the FBI, DEA, OIG, HHS, DOJ, DOD, and other government agencies. You will receive subpoenas to provide billing, corporate, financial, business, and communication records.
They will review your records. During this time, they can be in contact with your health care fraud defense attorney. The government will make the determination of whether or not it will support the qui tam case. If it does not, it will drop out. However, the plaintiff still has the right to pursue his or her claim against you. If the government supports the qui tam case, known as intervention, you may face additional allegations such as violating the Anti-Kickback Act and the Truth in Negotiation Act.
It’s important that your health care fraud defense lawyer is in contact with government agencies during the investigation. These cases can take months, and it’s better to have an attorney involved early in the process to help you resolve the matter in the best way possible.
Remember that if you’re found civilly or criminally liable for violating the False Claims Act, you could face some severe consequences such as treble damages and steep fines. If the government drops out and the qui tam plaintiff continues his or her suit against you and wins, the plaintiff is then allowed to keep up to 30 percent of the money recovered. If the government remains involved, the qui tam plaintiff is entitled to 25 percent of the recovered funds.
The Criminal Defense Firm’s Proven Defenses
The Criminal Defense Firm has an experienced Health Care Fraud Defense Team. We’ve successfully negotiated False Claims Act cases throughout the United States. We use a core set of principles to minimize the risk of criminal liability for our clients.
- Early intervention. Our first goal is to help you avoid criminal charges. The best way to do that is to get involved early in the investigation. We use our experience in federal health care fraud and False Claims Act investigations to get the answers that you need. We can usually find out within 48 business hours whether the investigation is civil or criminal, what the government is looking for, and how this issue can be resolved. A criminal charge could affect your livelihood. Our goal with early intervention is to lessen the risk of criminal charges and help resolve the complaints against you or your business.
- Avoid government intervention. Because many False Claims Act investigations are a result of angry former employees and competitors, we work to challenge their evidence and question their credibility. Doing so helps avoid government intervention. Claims made by angry former employees and competitors can ruin your business. Challenging their credibility is key because it shows the government that the qui tam plaintiff has made unfounded claims and that those claims should not be supported.
- Favorable settlement. In many of our former cases involving civil liability, we’ve successfully negotiated the damages to a small portion of the government’s original demand. To date, none of our clients had to stop practicing or shut down their business because of a violation of the False Claims Act.
Each False Claims Act investigation is unique. The key to successfully resolving it is early intervention. Call The Criminal Defense Firm right away to discuss your case. Our initial consultations are confidential and free of charge. We’re available 7 days a week. Call us, use our online contact form, or email us to get started.
Call The Criminal Defense Firm today and speak with former federal prosecutors and established defense counsel about your case. All initial consultations are free and confidential.
We are available to discuss your case. You can call us directly or complete our contact form or by sending us an email.
The Criminal Defense Firm
Serving: Westbury, Chinatown, Sharpstown, Braeburn, Missouri City and ALL of Houston!
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