Medicare Fraud Legal Defense

2011-12-12T00:52:00.000-08:00

On July 30, 1965 President Lyndon B. Johnson signed The Social Security Act into law: this legislation included the establishment of the Medicare program.

Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over and to those who are under 65 and are permanently physically disabled or who have a congenital physical disability, or who meet other special criteria. Medicare is administrated by the Centers for Medicare and Medicaid Services (CMS), which is a component of the Department of Health and Human Services (HHS).
Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks.

Prescription Fraud:
There are several types of Medicare Fraud; for consumers, one of the most prominent charges involves prescription fraud. Prescription fraud criminal charges are most often filed against people suffering from chronic pain and serious medical problems. In fact, most people who commit this crime have been legally prescribed the medication in the past for a specific medical purpose then become addicted.
It is illegal for anyone to alter a prescription written by a medical doctor. For example, a person cannot increase their prescription or change the type of medication they were prescribed. People are also caught phoning in fake prescriptions and impersonating medical personnel. Another common type of prescription fraud is forging the label.

If you are prescribed a medication from one doctor, it is illegal to visit other doctors in an attempt to try to get more prescriptions written for you. This is called doctor shopping and it is illegal. There have also been cases where medical staff or patients steal blank prescription pads. With the advent of the Internet, some people try to get their prescriptions filled online in a fraudulent manner.

Though legal consequences for drug charges can be severe, alleged violators of prescription medication laws often experience leniency from the court system when working with a thoroughly prepared criminal defense attorney because the accused is often facing his or her first criminal offense.
Prescription fraud also rates low in the courts' "culpability index" because no one was injured or suffered significant loss because of the alleged crime, and the courts tend to be lenient on defendants driven to commit crimes because of excessive physical pain.

This is a sensitive area of law and one that requires a committed defense attorney. Your attorney will review your statements to see if any of your rights were violated. Your attorney may also be able to help reduce the charges against you and substitute drug assessment for jail time.

Medicare/Medicaid Fraud:
As health care becomes an increasingly prevalent concern, more lawsuits are filed against health care providers. Meanwhile, laws pertaining to such lawsuits are constantly changing. Any health care provider accused of fraud must hire the best defense attorneys available or risk losing their business to spurious charges. The federal government is vigilant in trying to catch institutions trying to bill for services not rendered, creating fraudulent cost reports, making kickbacks or self-referrals, etc. They frequently assemble thorough, well-researched health care fraud cases.

Most Medicare payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. However, there are a few individuals who are intent on abusing or defrauding Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually.

HIPAA or HCFAC Fraud:
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established the national Health Care Fraud and Abuse Control Program (HCFAC). Under the joint direction of the Attorney General and HHS (acting through HHS' Office of Inspector General), the HCFAC program is designed to coordinate Federal, State and local law enforcement activities concerning health care fraud and abuse.
HIPAA calls for civil and criminal penalties for privacy and security violations, including fines up to $25K for multiple violations of the same standard in a calendar year and fines up to $250K and/or imprisonment up to 10 years for knowing misuse of individually identifiable health information.

Health Insurance Fraud:
False or excessive claim filling occurs when a healthcare provider attempts to bill the insurance company for a service that was not actually performed. The provider may attempt to bill the insurance company for equipment and supplies that were not used, or which may be determined to be excessive given the nature of the service. This causes the claim to increase and can also cost the patient an additional fee.
As the nation focuses on health care costs, health care providers and billing services have come under ever closer scrutiny, resulting in a surge in criminal charges. Any health care provider accused of fraud must hire the best defense attorneys available or risk losing their business to ill-founded charges.

FDA Fraud:
Individuals and companies under FDA, USDA, and DEA jurisdiction are subject to stringent public health statutes. Violation of these statutes carries the risk of civil liability, as well as criminal liability.
An increase of federal FDA investigators has led to an elevated level of inspections across the United States and abroad. Consequently, there has been an array of new violations as well as repeat violations. Repeat violations result in the formation of industry trends and can be quite alarming when you consider that different areas of the country and world are making the same mistakes.
More than 60 firms have been placed on the Import Alert #95-04 Red List for importing a range of laser products that do not comply with FDA labeling and safety data. Violations have included failure to provide the required certifications and warnings, submitting false entry documents, or not submitting the correct safety documentation to the FDA’s Center for Devices and Radiological Health (CDRH). Any firm placed on IA #95-04 will have their products Detained Without Physical Examination (DWPE) at Customs.

If you believe you may be under federal investigation for a Healthcare Fraud Case, it is critical that you hire a qualified criminal defense attorney right away. Do not risk having your rights violated by neglecting to retain a skilled, experienced criminal defense attorney.
The Houston, Texas law office of Kuniansky & Associates will work diligently to ensure your rights are protected.At Kuniansky & Associates we have the skills necessary to effectively defend individuals and corporations charged with a range of serious federal and state crimes. We are committed to providing personal attention to every client and have a deep understanding of prosecutorial strategies, conducting thorough investigations and preparation in every case. We have more than 30 years of valuable trial experience to bring to your defense.

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Medicare Fraud Legal Defense