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Rhode Island Federal Healthcare Fraud Charges

You do not need to fight federal healthcare fraud charges alone.  Our highly skilled Rhode Island Federal Criminal Defense Attorneys at Marin and Barrett, Inc. are here to help you fight allegations of federal healthcare related fraud.  There are time tested and proven defenses and strategies to fight federal fraud charges including grand jury indictments for healthcare fraud. 

If you have been arrested or indicted in Rhode Island on fraud charges related to the healthcare, it is important to seek experienced legal advice as soon as possible.  Our experienced federal criminal defense attorneys will meet with you and confidentially discuss the facts of your case, any legal or constitutional defenses you may have and your best strategy going forward.  We have handled many similar cases and can put our experience and knowledge to work for you right away.

Rhode Island Federal Healthcare Fraud Lawyers
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What is federal health care fraud in Rhode Island?

Federal health care fraud is defined as when a person knowingly and willfully executes a scheme that defrauds any federal health care benefit by false pretense, representations or promises to obtain money or property controlled by any health care benefit program.  In simpler terms, under 18 U.S.C. Section 1347, it is a federal crime to use deception against a health care benefit program (such as Medicare or Medicaid) in order to obtain a benefit (typically money or valuable services) that you otherwise would not be entitled to.

There are a number of actions that can trigger a federal investigation and subsequent arrest for health care fraud.  These actions include: visiting multiple doctors for the purpose of obtaining multiple prescriptions; using someone else's ID card for the purpose of obtaining medical services or prescription coverage; submitting fraudulent claims for financial gain; and adding ineligible people to a policy, among others fraudulent activities within the healthcare system.

What are the types of federal charges that a person can face for health care fraud?

The federal statutes that are closely entwined with health care fraud include:

  • 18 U.S.C. Section 1347 (Health Care Fraud);
  • 18 U.S.C. Section 1349 (Attempt or Conspiracy to Commit Health Care Fraud)
  • 18 U.S.C. Section 1320a-7b(b) (Health Care Kickbacks);
  • 18 U.S.C. Section 1320d-6 (Unlawful Use of Health Information);
  • 18 U.S.C. Section 669 (Theft or Embezzlement in Connection with Health Care).

What are common types of healthcare fraud in RI?

In addition to the actions previously mentioned above that can trigger federal investigations and or prosecutions, other common examples of health care fraud include:

  • “Upcoding” services – that is where healthcare providers submit inaccurate billing codes to insurance companies in order to receive inflated reimbursements;
  • “Upcoding” of items – that is where healthcare providers bill for items that were more costly than what the patient received;
  • Billing for services not rendered – that is where healthcare providers bill Medicare for services that were never rendered or which the patient did not need;
  • Unbundling – fraudulent scheme whereby a healthcare provider bills for individual procedures that are usually performed and billed together under a single code;
  • Providing excessive services – as when a health care provider bills Medicare for services greater than what a patient actually required under the circumstances; and
  • Unnecessary services – filing Medicare claims for care that a patient did not need.

Can you go to jail for health care fraud?

Yes.  Although some health care fraud associated statutes provide for civil liability (i.e. fines), prison is a distinct possibility for health care fraud under 18 U.S.C. Section 1347.

How does the U.S. Government prove health care fraud?

The US Government must prove beyond a reasonable doubt that an individual knowingly and willfully executes (or attempts to execute) a scheme to defraud any health care program or obtain by means of deception/false pretenses/representations any money/property/service of any health care benefit program.  In short, there must be a showing of intent to defraud.

Is federal health care fraud a felony?

Yes, federal care fraud is a felony criminal offense, which means it is punishable by a prison sentence greater than one year.

What is conspiracy to commit health care fraud?

In general, a conspiracy is when two or more persons conspire or work/plan together to bring about a particular result.  With respect to healthcare fraud, 18 U.S.C. 1349 makes it a separate crime from healthcare fraud (under 18 U.S.C. 1347) to conspire to commit healthcare fraud.  This means that in addition to being charged with healthcare fraud, a person could also be separately charged with conspiracy to commit healthcare fraud if the fraudulent act was committed in conjunction with one or more persons.  

Here is an example, a few (or several) people agree that they will recruit individuals from the neighborhood to claim eligibility for Medicare benefits and then send the qualified individuals (“patients”) to a local doctor who is also a member of the conspiracy. 

The individuals in the conspiracy (and the recruiters) are given a payment or “kickback,” while the doctor's office receives reimbursement from Medicare for supposedly providing medical services to the recruited individuals.  In reality, however, the doctor's office does not provide services for which they claim or receive reimbursement from the federal government. 

In this example, every individual involved who had knowledge that the activity was fraudulent - the recruiters, the “patients”, and the doctor's office, would all be potentially charged with a federal healthcare fraud conspiracy in violation of 18 U.S.C. Section 1349.

How long do you go to jail for health care fraud in Rhode Island?

A violation of 18 U.S.C. Section 1347 for federal health care fraud is punishable by a maximum of 10 years in prison and/or a fine.  The maximum is raised to 20 years in prison if the violation results in serious bodily injury to an individual; and if the violation results in death, the maximum penalty is life in prison.

Under the federal conspiracy statute, 18 U.S.C. 1349, “any person who attempts or conspires to commit [healthcare fraud] shall be subject to the same penalties as those prescribed for the offense, the commission of which was the object of the attempt or conspiracy.  In short, the penalties for conspiracy to commit health care fraud are the same as the penalties for health care fraud.

How has the federal government responded to healthcare fraud cases during the COVID-19 pandemic?

Aggressively.  In fact, on March 16, 2020, the US Attorney General, William Barr sent a memo out to U.S. Attorneys reminding them to remain vigilant in investigating, detecting, and prosecuting healthcare fraud.  As a result, numerous arrests have occurred since the start of the pandemic.  Some of the notable cases are listed below.

What can a Rhode Island Healthcare Fraud Defense Lawyer do for you?

There are proven and time tested defense and strategies to healthcare fraud cases.  In fact, a skilled federal criminal defense attorney can raise the defense of lack of intent, lack of knowledge (of the scheme not the illegality), and many other defenses. 

If you have been arrested or indicted in Rhode Island for healthcare fraud, it is important to seek experienced legal advice as soon as possible.  Our experienced federal defense attorneys will meet with you and confidentially discuss the facts of your case, any legal or constitutional defenses you may have and your best strategy going forward.  We have handled numerous cases and can put our experience and knowledge to work for you right away.  Contact us today at 401-228-8271 for a no obligation federal healthcare fraud defense strategy session.

Kensley Barrett

Our law firm was founded on the belief that working with us is more than just hiring a lawyer. Working with us will bring you peace of mind and also allow you to continue with your regular life while we attend to your legal matters. Our vast experience means that it allows us to excel in both aggressively representing your interests and generating the best possible result for you.