Healthcare Fraud Defense Appeal Lawyers

Brownstone Law Medical Fraud Appeal Attorneys focus 100% on appeals in all eleven circuits in the United States. The medical fraud appeal attorneys of the Brownstone Law firm are here to help you make sure you are treated fairly and justly in a court of law. Are you dealing with healthcare fraud issues? The Medical Fraud Appeal Attorneys of Brownstone Law are glad to help you with any sort issues that you might be encountering. We are more than willing to help you with any EIRSA appeals or conspiracy, as well as Medicaid fraud and Medicare fraud. In addition, Brownstone Law is ready to help you with your insurance fraud, over billing, improper billing, false medical claims, improper coding practices, claims adjudication fraud, accepting kickbacks, Medicare/Medicaid fraud, over-billing, tax fraud violations and even internet pharmacy violations.

Contact our federal healthcare fraud criminal appeals attorneys 1-888-233-8895.

Experienced Federal Medical Fraud Appeals Attorneys

Medical procedures always carry at least a small amount of risk so it is important that, as a patient, you have someone on your side to help you should things somehow go awry. The federal appeals lawyers at Brownstone Law have many years of combined professional experience. Are you suffering from improper solicitation of patients? Our on-hand federal crime appellate lawyers will be able to help you with your improper solicitation of patient’s issue.   Return to our federal criminal appeals page.

Medical insurance fraud

Many federal medical prosecutions have been cases that concern inappropriate contact with patients. Inappropriate contact with patients can leave serious scars on the patient, physical and metaphorical. Patients put their trust in the hands of doctors on a daily basis. It is obvious that something can go wrong during a visit to a doctor’s office; that is why it is important to have some help on your side. Brownstone Law is here to help you with your medical fraud case should you need assistance. From over-prescribing controlled medication to criminal negligence in the practice of medicine, the Medical Fraud Appeal Attorneys at Brownstone Law are well-versed in the field of medical fraud and are more than capable of helping you get the treatment and respect that you deserve.

 

Federal Medicare Fraud Appeals

Have you recently been the victim of Medicaid fraud? What about Medicare fraud? From insurance fraud, over billing, improper billing and false medical claims to improper coding practices, claims adjudication fraud, accepting kickbacks, tax fraud violations, overbilling, Medicare / Medicaid fraud, internet pharmacy violations and improper solicitation of patients, the great appellate lawyers of Brownstone Law possess the education and experience that is necessary to help you win your medical fraud appeal case. Brownstone Law can even help you with inappropriate contact with patients, over-prescribing controlled medication as well as criminal negligence in the practice of medicine. If you are seeking assistance with a medical fraud case, call the good people at Brownstone Law today.

Contact Brownstone Law today to discuss your federal criminal appeal (888) 233-8895.

According to John Hopkins Medicine, “Fraud is defined as any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act or someone else who is similarly not entitled to the benefit.”  Further examples of healthcare frauds are stated as follows:

  • “Misrepresentation of the type or level of service provided;”
  • “Misrepresentation of the individual rendering service;”
  • “Billing for items and services that have not been rendered;”
  • “Billing for services that have not been properly documented;”
  • “Billing for items and services that are not medically necessary;”
  • “Seeking payment or reimbursement for services rendered for procedures that are integral to other procedures performed on the same date of service (unbundling);”
  • “Seeking increased payment or reimbursement for services that are correctly billed at a lower rate (up-coding).”

Health Care Fraud is a very serious crime that has severe punishments ranging from lengthy prison time to hefty fines. Our company has a number of highly experienced defense attorney’s that could help defend you in health care fraud cases and can strategically protect your rights and interests.

Kickbacks, Bribes and Rebates

According to the federal Anti-Kickback Statute, if any provider of health care services “knowingly and willfully offer or pay any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce” it can be considered a federal offense. This includes lease, purchase and patient referral where payments are done through federal health care benefit program funds. Anyone receiving such kickback, bribe, or rebate as well can be convicted under the Federal Law.

 

Despite the language of the Anti-Kickback Statute that mentions the words “knowingly and willfully”, it has been entrenched by the Patient Protection and Affordable Care Act (PPACA) and federal case law that it is not necessary for an individual to have actual knowledge of the illegal payment taking place. It is because of this act that health care service providers who unconsciously become a part of such illegal kickbacks and rebates might have to face federal prosecution.

The federal Anti-Kickback Statute covers the following forms of “remunerations” –

  1. Free or below fair market value use of clinical space, equipment or staff
  2. Cash payments
  3. In-kind gifts (such as airplane tickets)
  4. Certain marketing commissions
  5. Discounts for services, supplies, or equipment
  6. Payments to family members

The Anti-Kickback Statute despite having a broad scope does not have absolute prohibitions. For instance, W-2 employees can be compensated by the providers (in accordance with enumerated factors and subjected to certain limits) only in cases where the payments would be considered illegal kickbacks when they are being made to a contractor or an independent party. Under this law there is a special provision made to safe harbor certain types of transactions. Moreover, some purchasing arrangements and risk sharing have been exempted from this Statute.

Physician Self-Referrals

The Stark Law imposes additional restrictions on the practicing physicians, unlike the Anti-Kickback Statute that broadly applies to all the healthcare providers in all the various segments of the healthcare industry that comes under the federal health care benefit programs. Under the Stark Law any transactions taking place that could qualify as “physician self-referral” are prohibited. The so called “physician self-referral” is referred to as a referral for “designated health services” that can only be provided by an entity that has formed a “financial relationship” with the referring physician.

For authorities that look forward to cracking down improper billings to Medicare and other benefit programs the Stark Law has proved to be a potent weapon due to its broad scope. This is because the definitions of both “designated health services” and “financial relationship” cover a broad spectrum.

These Designated health services include:

  1. DME and medical supplies
  2. Inpatient and outpatient hospital services
  3. Outpatient pathology
  4. Outpatient prescriptions
  5. Clinical laboratory services
  6. Parenteral and enteral nutrients, equipment, and supplies
  7. Physical therapy
  8. Home health services
  9. Imaging
  10. Prosthetics, orthotics, and related supplies]
  11. Radiology and radiological therapy

 

Financial relationships that can trigger Stark Law implications include:

  1. Direct investment
  2. Indirect investment (compensation arrangements)
  3. Company or practice ownership
  4. Direct compensation arrangements

The Stark Law (just like the Anti-Kickback Statute) has limited exceptions that would only apply in very specific cases. If you are convicted under the Stark Law, then proving that you can qualify as an exception will be your key defense strategy. Having a sufficient amount of documentation that shows a qualifying financial relationship is necessary to avoid any liability.

Billing for Services, Supplies, or Equipment Not Provided

The Centers for Medicare and Medicaid Services (CMS), DOJ, OIG, Department of Defense (DOD), Medicare Fraud Strike Force, and other federal authorities are some of the key investigators of cases that involve billing for services, supplies, and equipment that are not provided or given to patients. In the context of intentional Medicare and Tricare fraud schemes such practices are widely known as “phantom billing”. However, this could also be a result of non criminal activity like unintentional coding errors, typographical errors, misreading of patient records by the administrative staff, that do not require any federal enforcement action to be taken.

 

It is critical for your business or practice to get to the bottom of the allegations of fraudulent reimbursement requests for services not rendered or supplies not provided as soon as possible. This is necessary because there could be high chances of the government finding evidences that could connect your business or practice to health care fraud. Our lawyers are well equipped to proactively deal with any mistakes made by someone within your business or practice, and provide you with a tailored defense with the main objective of insulating you, your company, and its employees from any criminal allegations.

Fraudulent Physician Certifications

It is necessary for the beneficiary of any health care program to have his/her eligibility certified through a physician in order to be covered for hospice care or home health care. The certification must be done independently by the physician’s own examination and the results of the examination should be free from the influence of external factors such as a financial motive. Health care fraud investigators who focus on targeting home healthcare service providers and hospice providers commonly deal with Fraudulent Physician Certification Allegations. Moreover physicians also face such allegations.

Some of the common allegations in such cases are mentioned below.

  1. Home providers and hospices create fraudulent and forged physician certifications.
  2. Physicians creating fraudulent certifications in exchange of bribes and kickbacks.
  3. Accepting home health or hospice certification from any other physician other than the patient’s primary care physician.

 

Frauds also occur in patient recertification as well. It is mandatory for the all home health patients to get recertified every 60 days by the attending physician regarding whether or not home health care is required by the patient as per his/her professional judgment. Both the certification and recertification have the same criteria and standards. In cases where the physician forges the recertification, he can be charged with criminal and civil penalties.

Issues with Election Statements for Hospice Care

Along with the physician certification, a patient is required to sign an election statement to get Medicare to cover his/her hospice care expense. Two acknowledgments that are mandatory to be included in the election statement are –

 

  1. The patient is fully aware about the palliative (not curative) nature of hospice care.
  2. The patient will be waiving off his/her right to any Medicare coverage for the treatments that are not provided or arranged for by his/her hospice services provider.

 

To prevent any prosecution in a federal investigation regarding the hospice care, they are advised to keep all their patient’s election statements. In addition to this the hospice are required to respect the choice of their patients to revoke their election at anytime. In situations where the hospice is unable to account for its patients’ election statements for which Medicare has already been charged for, it will have to face federal prosecutions.

 

Defending Against Health Care Fraud Charges

The government is required to prove the convicts intention to defraud and not just prove that the alleged has attempted or completed the fraud. This means that the officials have to prove that the fraud had been committed with intent and was not merely a mistake. Our firm will provide you with defense attorneys who are well versed with the complexity of the laws that regulate health care and pertain to your case. We start our work to defend you well before the case goes to trial right upto when you have received a fair verdict . Our attorneys are here to investigate your case thoroughly, tell you about your rights and all the legal procedures.

 

Due to the complexity of the Healthcare industry, such allegations are rigorously investigated and regulated by federal agencies such as the DEA and the FBI. As so many federal agencies are involved in such cases, it is common for a healthcare provider to encounter serious allegations that could hamper their reputation that would directly or indirectly impact their career, their future and their families.

Providing Aggressive Defense for Healthcare Providers

Our firm represents healthcare providers ranging from doctors, medical equipment providers and pharmacists to pharmaceutical sales reps in a wide range of cases related to healthcare fraud allegations such as –

  1. Medicare fraud
  2. Medicaid fraud
  3. Durable medical equipment (DME) billing
  4. Prescription drug crimes
  5. Overbilling
  6. Overprescribing
  7. Fraudulent Certification

Preparing A Legal Defense Against Health Care Fraud

Ambiguity and vagueness of a health care fraud makes it equally difficult for the government to prove you guilty and for you to prove innocence because proof of intent is the sole requirement for a health care fraud  conviction. Despite the situation at hand, you must get out of the investigation by the government. So obviously the first step is to hire an experienced and knowledgeable Medicare fraud defense attorney. In addition to this you must disclose any violations taking place under the protective provisions of the False Claims Act. Read more about federal healthcare fraud appeals and Brownstone Law. But most of these provisions apply only under specific circumstances and before providing any information to the government authorities you should consult and discuss your situation with a knowledgeable health care fraud defense lawyer.

Medical Fraud and Healthcare Appeals

Raakesh Bahn, M.D. v. Battle Creek Health Systems (Case No. 13-1682)

This case arises out of the suspension of Dr. Raakesh Bhan’s medical staff privileges at two Michigan hospitals: Battle Creek Health System (“BCHS”), located in Calhoun County, and Borgess Medical Center (“Borgess”), located in Kalamazoo County. On February 26, 2010, Dr. Bhan filed suit against the hospitals, its parent companies, and various individuals who helped bring about the suspensions. R.E. 1, Page ID# 1-15. The Defendants-Appellees moved to dismiss the complaint in March of 2010. R.E. 14, Page ID# 343-45; R.E. 16, Page ID# 365-93; R.E. 19, Page ID# 401-29.  Read more about this federal civil appeal:  Bhan-IB

Jonathan Agbebiyi. v. United States (Case No. 12-2559)

On February 17, 2011 Dr. Agbebiyi was indicted with ten other individuals for conspiracy to commit healthcare fraud, and subjected to criminal forfeiture. (D.E. 3, Pg ID 7-17). Also charged were Karina Hernandez, Marieva Briceno, Dora Binimelis, Santiago Villa-Restrepo, Juan Villa, Isaac Carr, Diana Brown, Jasmine Oliver, and Henry Briceno. Id. The original indictment was superseded on August 18, 2011, September 12, 2011, and April 24, 2012. (D.E. 104, Pg ID 422-38; D.E. 113, Pg ID 457-74; D.E. 246, Pg ID 1327-39). As to Dr. Agbebiyi, the original indictment was expanded to include six counts of healthcare fraud.  Read more here: Agbebiyi-Healthcare appeals federal

Call Brownstone Law today to review your federal appeal (888) 233-8895.

Our federal healthcare defense attorneys have gathered solid experience over the years and are well aware of  the different laws and protections you are entitled to. At the Brownstone Law firm, you can be assured of thorough investigation of the circumstances surrounding your case and efficient defense of your case from the pre-trial phase all the way through post-trial. We also take responsibility for providing expert advice as to your rights and options under the law so that you are well-informed. We are fully aware of manipulations, pitfalls or unjust actions that the courts and the prosecutors may engage in and we will fight for you to make sure your rights under the law are protected.

Contact our federal healthcare fraud appeals lawyers today at 1-888-233-8895

 

 

 

 

 

 

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