Last Updated on: 28th October 2023, 10:02 pm

I’ve Been Charged with Healthcare Fraud – Will I Go to Jail?

Being charged with healthcare fraud can be an incredibly stressful and frightening experience. The prospect of potentially facing jail time, heavy fines, and other penalties is daunting. However, it’s important to understand the charges, your rights, and possible defenses. This article provides an overview of healthcare fraud laws, typical penalties, and strategies to mitigate consequences.

What is Healthcare Fraud?

Healthcare fraud refers to intentionally deceiving or misrepresenting information to obtain money or benefits from healthcare programs like Medicare or Medicaid. There are many types of healthcare fraud, including:

• Billing for services that were never provided
• Billing for unnecessary medical services
• Billing for services at a higher rate than provided
• Accepting kickbacks for patient referrals
• Using someone else’s insurance information
• Prescribing medications for reasons other than medical need

Most healthcare fraud charges are brought under the federal False Claims Act or Anti-Kickback Statute. However, states have their own laws too. The penalties can be severe if convicted, including fines up to $250,000 and imprisonment for up to 10 years.

What are the Typical Penalties for Healthcare Fraud?

The specific penalties for a healthcare fraud conviction really depend on the details of the case. But generally, the punishments may include:

• Prison time – This ranges widely based on the offense, from 0 to 10+ years in federal prison.
• Fines – From $250,000 to over $1 million in fines per offense.
• Restitution – Having to repay all wrongfully obtained funds.
• Exclusion – Being banned from federal healthcare programs.
• Forfeiture – Having assets seized that were obtained illegally.

Judges determine sentences based on the Federal Sentencing Guidelines and factors like:

• The amount of financial loss caused
• The number of victims
• The sophistication of the fraud
• Obstruction of justice
• Prior criminal history
• Acceptance of responsibility

It’s impossible to predict any case’s outcome. But typically, large-scale, intentional, and repetitive fraud has the harshest sentences. Minor, unintentional errors may just lead to repaying funds.

What are Possible Defenses Against Healthcare Fraud?

There are several legal defenses that may be effective in contesting healthcare fraud charges:

• Lack of intent – One defense is that you did not intentionally commit fraud, but made an honest mistake.
• Lack of knowledge – You can claim you were unaware of wrongdoing and unaware the claims were false.
• Statute of limitations – There is a 5-year limit on prosecuting healthcare fraud after it was committed.
• Entrapment – Arguing law enforcement induced you to commit fraud you otherwise wouldn’t have.
• Duress – Saying you were coerced into committing fraud under threat.

An experienced healthcare fraud defense lawyer can assess which defenses may apply in your specific case. They can also negotiate with prosecutors for reduced charges or sentences.

What are the Consequences Other Than Jail Time?

Even if you avoid prison, a healthcare fraud conviction can still impact your life severely through:

• Fines and repayment of funds, which can equal millions.
• Being banned from working in healthcare programs.
• Losing professional licenses.
• Hurting future employment prospects.
• Having assets or property seized.
• Harming your reputation.

These consequences can destroy careers and financial stability. It’s critical to take charges very seriously and retain legal counsel immediately.

What Should I Do if Charged with Healthcare Fraud?

Being charged with healthcare fraud can be terrifying. But these tips may help guide your response:

• Remain silent – Do not try to explain anything to investigators yet.
• Hire an attorney – Retain an experienced healthcare fraud lawyer immediately.
• Follow legal counsel – Listen to your lawyer’s advice about how to proceed.
• Review records – Go through your records to understand the charges.
• Consider defenses – Discuss possible defenses with your lawyer.
• Explore options – Your lawyer can negotiate reduced penalties potentially.

With an experienced legal defense, you may be able to mitigate penalties or even get charges dismissed. Don’t panic, but take the charges very seriously and get help defending yourself.

The Bottom Line

Healthcare fraud allegations should never be taken lightly given the severe potential penalties. While jail time is possible, the specific punishment really depends on the case details and applicable defenses. Regardless of the outcome, healthcare fraud charges can negatively impact careers, finances, and reputations for years. If charged, immediately retain experienced legal counsel to protect your rights and future.