Healthcare Fraud Defense Lawyer

Facing accusations of healthcare fraud can be a terrifying and overwhelming experience. The complexities of healthcare law, coupled with the aggressive tactics employed by government agencies, can leave you feeling vulnerable and uncertain about your future. The government pours significant resources into investigating and prosecuting these cases, often seeking severe penalties that can have devastating consequences for your career, reputation, and personal life.

In these challenging times, you need an attorney who not only understands the intricacies of healthcare law but also possesses the experience and tenacity to fight for your rights. Michael Padula, founder of Padula Law, offers a unique advantage. As a former prosecutor, he has an insider’s perspective on how these cases are investigated, charged, and prosecuted. He knows the strategies used by the government, anticipates their moves, and leverages this knowledge to build a powerful defense for his clients.

Choosing the right attorney can make all the difference in the outcome of your case. Michael Padula’s experience, combined with his dedication to protecting his clients’ rights and reputations, makes him the ideal advocate for anyone facing healthcare fraud allegations.

Types of Healthcare Fraud Cases Defended

Healthcare fraud is a broad term that encompasses a wide range of illegal activities aimed at defrauding government healthcare programs or private insurers.

Padula Law provides comprehensive defense services for individuals and organizations facing allegations such as:

• Submitting false claims: This includes billing for services not rendered, medically unnecessary equipment or procedures, or inflated charges. It also covers submitting claims for patients who don’t exist or who never received the treatment in question.
• Kickbacks: Receiving illegal payments, gifts, or other benefits in exchange for patient referrals, prescriptions, or other healthcare-related services. This can also involve paying kickbacks to induce referrals or generate business.
• Upcoding: Billing for a more expensive service or procedure than the one actually provided to a patient. This can involve using incorrect billing codes or misrepresenting the level of service provided.
• Unbundling: Billing separately for services or procedures that should be billed together as a single unit. This artificially inflates the cost of care and results in overpayment from healthcare programs.
• Violating Medicare/Medicaid provisions: This encompasses a variety of offenses, including making false statements on applications or contracts, engaging in prohibited billing practices, and failing to comply with program requirements.
• Over-utilization of services: Providing or billing for an excessive number of services that are not medically necessary. This can include ordering unnecessary tests, prescribing excessive medications, or providing treatments more frequently than required.
• Lack of medical necessity: Billing for services or procedures that are not medically necessary for the patient’s condition. This can involve providing treatments that are not supported by medical evidence or that do not benefit the patient.
• Utilization of excluded providers: Employing or contracting with healthcare providers who are excluded from participating in federal healthcare programs due to previous fraudulent activity or other misconduct.

Understanding the Healthcare Fraud Investigative Process

Healthcare fraud investigations can be triggered by a variety of sources, including:

• Whistleblower complaints: Current or former employees, patients, or competitors may report suspected fraudulent activity to government agencies. These whistleblowers may be eligible for a portion of any recovered funds.
• Audits: Government agencies regularly conduct audits of healthcare providers to ensure compliance with billing regulations and program requirements. These audits can uncover irregularities that lead to further investigation.
• Internal reviews: Healthcare organizations may conduct internal investigations in response to suspected fraud or compliance issues. These investigations may be initiated by compliance officers, internal auditors, or other staff members.
• Data analysis: Government agencies utilize sophisticated data analysis techniques to identify patterns and anomalies in billing data that may indicate fraudulent activity.

Once an investigation is initiated, government agencies like the Department of Justice (DOJ) and the Department of Health and Human Services Office of Inspector General (HHS-OIG) may employ a variety of investigative tactics, including:

• Interviews: Investigators may conduct interviews with employees, patients, and other individuals who may have information relevant to the investigation.
• Document reviews: Investigators may subpoena or request a wide range of documents, including medical records, billing records, financial statements, and emails.
• Search warrants: In some cases, investigators may obtain search warrants to seize documents, computers, and other evidence from healthcare facilities or private residences.
• Subpoenas: Investigators may issue subpoenas to compel individuals to testify before a grand jury or produce documents.

It is crucial to seek legal counsel as soon as you become aware of a healthcare fraud investigation. An attorney can help you understand your rights, protect you from self-incrimination, and guide you through the complexities of the investigative process. Early intervention by an experienced attorney can significantly impact the outcome of your case.

Potential Consequences of Healthcare Fraud

Healthcare fraud is a serious offense with potentially devastating consequences. If convicted, you could face:

• Criminal charges: These can range from misdemeanors to felonies, depending on the severity of the offense. Penalties may include imprisonment, substantial fines, and restitution to the government or private insurers.
• Civil lawsuits: The government or private insurers may file civil lawsuits to recover damages and penalties. These lawsuits can result in significant financial liability, even if you are not convicted of criminal charges.
• Exclusion from federal healthcare programs: A conviction or even an allegation of healthcare fraud can lead to exclusion from participation in Medicare, Medicaid, and other federal healthcare programs. This can effectively end your career as a healthcare provider.
• Reputational damage: Accusations of healthcare fraud can severely damage your professional reputation and your standing in the community. This can make it difficult to find employment or rebuild your practice.
• Loss of license: In some cases, healthcare professionals may face disciplinary action from their licensing boards, including suspension or revocation of their license to practice.

Why You Need an Attorney if You Are Accused of Healthcare Fraud

Facing a healthcare fraud investigation or prosecution alone is incredibly risky. An experienced attorney can provide invaluable assistance by:

• Protecting your rights: Ensuring that your constitutional rights are protected throughout the investigative and legal process. This includes the right to remain silent, the right to an attorney, and the right to a fair trial.
• Building a strong defense: Conducting a thorough investigation of the allegations, gathering evidence, and identifying weaknesses in the government’s case. This may involve consulting with medical and billing experts, reviewing financial records, and interviewing witnesses.
• Negotiating with agencies: Engaging in negotiations with government agencies to seek a favorable resolution to your case. This may involve negotiating a plea bargain, settlement agreement, or other alternative to trial.
• Advocating for you in court: Providing skilled and persuasive representation in court if your case goes to trial. This includes presenting evidence, cross-examining witnesses, and arguing legal motions.

Michael Padula’s unique experience as a former prosecutor makes him particularly well-suited to defend you against healthcare fraud allegations. He understands the government’s tactics and can anticipate their moves, giving you a significant advantage in your case. He is committed to providing aggressive and effective representation to protect your rights, your freedom, and your future.

Aggressive Defense Strategies

Padula Law takes a proactive and comprehensive approach to defending clients against healthcare fraud allegations. We employ a variety of aggressive defense strategies, including:

• Thorough investigation: We meticulously examine all evidence, including medical records, billing records, and financial documents, to identify inconsistencies, errors, and weaknesses in the government’s case.
• Expert witness consultation: We consult with leading medical and billing experts to challenge the government’s allegations and provide expert testimony in court.
• Negotiation with government agencies: We engage in skilled negotiations with government agencies to seek the best possible outcome for our clients. This may involve negotiating a plea bargain, settlement agreement, or other alternative to trial.
• Motion practice: We file pretrial motions to suppress evidence, dismiss charges, or exclude expert testimony.
• Strong courtroom advocacy: We provide skilled and persuasive representation in court, presenting a compelling defense and advocating for our clients’ rights.

Protecting Your License and Reputation

Michael Padula understands that your professional license and reputation are invaluable assets. He is dedicated to protecting your career and minimizing the impact of healthcare fraud allegations.

We work tirelessly to:

• Safeguard your license: We take proactive steps to prevent disciplinary action from licensing boards and professional organizations.
• Minimize reputational damage: We work to mitigate negative publicity and protect your standing in the community.
• Achieve the best possible outcome: We strive to secure a favorable resolution to your case that allows you to move forward with your life and career.

If you are facing a healthcare fraud investigation or have been charged with a healthcare offense, don’t wait to take action. We can help you understand your rights, develop a strong defense strategy, and protect your future. Call (888) 574-5155 or contact us online.

Frequently Asked Questions For Our Healthcare Fraud Defense Attorney