A key part of working in healthcare is following ethical and legal standards. This helps provide the best care for patients. Although it may not seem like a big deal at the moment, seemingly minor actions — such as submitting false claims to Medicare or accepting gifts in exchange for medical services — can be classified as healthcare fraud, which is a serious legal violation.
If your firm is facing allegations of healthcare fraud or abuse, there are specific steps you can take to defend yourself and protect your practice. Working alongside a healthcare fraud defense attorney who provides top-tier legal advice will help you achieve the best possible outcome for your case.
Here are important steps to take when defending against healthcare fraud claims. This will help protect your practice amidst the crisis and in the future.
Fraud and abuse are both illegal actions that can lead to serious legal and financial consequences. However, they differ in intent and severity.
Fraud involves intentional deception with the knowledge that the deception will result in unauthorized payment or benefits. It usually involves deliberately misleading others for personal financial gain, such as billing for services not provided, over-billing for services, or submitting false claims to Medicare or Medicaid.
Abuse, on the other hand, does not necessarily involve fraudulent intent but still violates healthcare regulations. Abuse involves actions that do not align with medical guidelines but typically does not involve the intent to deceive. Examples of abuse include providing unnecessary medical services or tests or over-using healthcare resources.
If an employee places himself over the well-being of his patients, it could put the entire healthcare practice at risk. Here are the initial steps to take when defending against healthcare fraud or abuse allegations.
Healthcare fraud attorneys will be your greatest asset when defending against fraudulent practices. Connecting with a healthcare fraud defense lawyer as soon as possible when facing allegations is your best bet.
These legal professionals have the specialized knowledge and experience you need to get through the investigation process and build a strong defense strategy. They will help gather and present the right evidence, ensure compliance with legal requirements, and protect your practice’s rights.
Before responding to external allegations, conduct a detailed interval review to assess how valid the claims actually are. This means looking into patient records, billing practices, and financial transactions to detect potential discrepancies.
Additionally, interview staff members who may have been involved and identify any gaps or errors in compliance. Without understanding the context of the situation and your practice’s role in it, you cannot effectively defend yourself.
Your healthcare fraud defense attorney will become most valuable when directly engaging with authorities. It is always important to work respectfully with investigators. Having a lawyer helps you understand your rights and can prevent you from accidentally incriminating yourself during questioning.
Your attorney can guide you on how to respond appropriately while keeping your practice’s best interests a priority.
A well-structured compliance program establishes clear policies to prevent, detect, and address illegal or unethical conduct. According to the HHS Office of Inspector General (OIG), an effective compliance program should include the following seven elements:
If your practice discovers any issues with its compliance program, you should address them immediately. This may involve revising policies, enhancing training, or making broader structural changes to ensure your practice adheres to legal and ethical standards.
Fenton Jurkowitz Law Group is a healthcare fraud law firm that has a team of seasoned defense attorneys who can guide you through fraud or abuse allegations. We don’t just give legal advice, we also want to help you solve the problem quickly and effectively.
We recognize the importance of preserving your reputation, maintaining operational continuity, and complying with healthcare regulations. Fill out our contact form on our website today to connect with a healthcare practice attorney.