Health Care Fraud

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Cincinnati Health Care Fraud Lawyer

Assisting Individuals and Health Care Providers in Cincinnati Facing Health Care Fraud Charges

Many individuals who reside in the State of Ohio depend on programs that are sponsored by the government – most especially when it comes to obtaining health care coverage. Since a large number of Ohioans rely upon government programs, the State is regularly monitored by the Medicare Fraud Strike Force.

The Medicare Fraud Strike Force is a federal organization. It encompasses numerous federal prosecutors and investigators who work with a laundry list of federal agencies, such as the United States Department of Justice (DOJ), the Department of Health and Human Services, and the Inspector General’s Office. When false Medicare claims are made, the Strike Force takes action by investigating such claims, and if necessary, prosecuting individuals, corporations, and other involved entities. 

If you or your organization is facing one or more criminal charges for health care fraud, the knowledgeable Cincinnati health care fraud lawyers at the Joslyn Law Firm can help defend you in your case and represent you in criminal court. Our legal team will explain all of the legal options available to you in your criminal case and can help you decide on the best option that suits your individual circumstances. Contact one of our financial crime attorneys today for more information. 

Overview of Health Care Fraud in OH 

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What Constitutes as Health Care Fraud in Cincinnati?

Health care fraud involves a person or company intentionally giving false information or acting deceptively to gain health care benefits or payment they do not deserve. There are a variety of different activities that constitute health care fraud in Cincinnati. In many instances, health care fraud occurs when a corporation or some other entity tries to secure reimbursement for a piece of medical equipment – or for medical services – from a program that is sponsored by the federal government. Sponsoring medical programs include Medicare, Medicaid, Tricare, and federal workers’ compensation.

One type of health care fraud in Cincinnati involves violating the Stark Law, also known as the Self-Referral Law. The Stark Law is in place to prevent medical doctors from referring a patient to a practice in which the referring doctor has some form of ownership interest or investment interest. Similarly, under the federal Anti-Kickback Law, a medical doctor cannot refer a patient to a practice in exchange for a stipend, kickback, or referral fee. The same applies not just to referrals between doctors but also between doctors and marketing representatives and business owners.

Another type of healthcare fraud involves prescription fraud. Prescription fraud investigations typically occur when a doctor or a medical practice runs a “pill mill.” “Pill mills” are slang for health care practices that issue numerous prescriptions for narcotic medications – especially when these prescriptions are issued within a short period of time.

Health care fraud may also occur when a provider engages in fraudulent billing practices, such as “upcoding” – or inflating medical bills. Inflating medical bills may involve using a code that is higher than the applicable code, in order to charge for a more expensive service that was never performed. Upcoding can also involve medical providers billing for patients who never sought treatment at their practice or billing for medical treatments or services that were not necessary.

A criminal charge for health care fraud can also come about in cases that involve fraudulent certifications for home health care, including hospice care. Finally, health care providers can face criminal charges for violating the Medicare False Claims Act. Violations of this act often involve submitting an inaccurate or false claim to a government-sponsored health care program, including Medicaid or Medicare. 

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Can a Health Care Fraud Conviction Mean Jail Time?

If you plead guilty or are convicted of health care fraud, it is up to the judge to determine your sentence and penalties, including whether you might go to jail. Some possible penalties include: 

  • 12 months in jail for fraud worth $1,000 to $7,500
  • 18 months in jail for fraud worth $7,500 to $150,000
  • Five years in prison for fraud worth more than $150,000

Moreover, if a patient’s death resulted from the alleged health care fraud, then a judge could impose a lifetime criminal sentence. Federal charges can result in more serious penalties according to the federal sentencing guidelines, which includes a possible stay in federal prison.

In addition to criminal charges for health care fraud, you may also be charged civilly, after which you may incur penalties and other consequences. In a civil health care fraud case, you might be required to repay the subject claim, or a government healthcare program might be able to exclude your health care practice from participation. Additionally, you may be penalized by the Ohio Disciplinary Board, and your medical license can be suspended or revoked. You may also lose one or more hospital privileges as a result of health care fraud that you or your practice committed. 

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Defending against Health Care Fraud Cases

In cases that involve health care fraud, the federal prosecuting attorney has the burden of proving that you or your organization committed the crime of fraud beyond a reasonable doubt. In order to demonstrate that you engaged in health care fraud, the prosecutor must demonstrate some degree of intent on your part. In other words, a mistake in billing or some other unintentional act is not sufficient to establish the legal grounds for health care fraud. 

At your criminal trial, your attorney may be able to argue mistake or some other legal defense on your behalf. By negating the intent element of health care fraud, an experienced Cincinnati health care fraud lawyer may be able to show that the prosecutor failed to meet his or her legal burden. Consequently, the health care fraud charge in your case might be subject to dismissal.

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Call a Cincinnati Health Care Fraud Lawyer Today

The legal team at Joslyn Law Firm can help you fight civil or criminal health care fraud charges. We help clients in the Cincinnati area, as well as in all Southwest Ohio courts, including in Montgomery County, Greene County, Warren County, Butler County, Hamilton County, Campbell County, Brown County, and Clermont County.

To schedule a free case evaluation and legal consultation with a Cincinnati health care fraud attorney, please call us at (513) 399-6289 or contact us online to learn more about how we can help you defend against your criminal charge.

  • Brian Joslyn was named Best Lawyer in 2019 by Birdeye.
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