Health care fraud can take a variety of forms, but it usually arises out of the improper billing of insurance carriers such as Medicare, Medicaid, Blue Cross & Blue Shield and other private payors.  Allegations of fraud can also extend into the arena of medical treatment and decision-making.  For example, providing services that are alleged to be medically unnecessary can give rise to a criminal investigation as well as the improper use of medical devices.  Indeed, we have seen an increase in federal investigations into the improper use of medical devices.

Under Michigan law, the Medicaid False Claim Act, MCL 400.601, et seq., makes it unlawful to make false statements or submit false Medicaid claims, punishable by four years’ imprisonment.  The Health Care False Claim Act, MCL 752.1001, et seq. makes it unlawful to submit false claims solicit or accept bribes or kickbacks in connection with other health insurance programs with varying penalties.  It is also a crime to knowingly place false information in a medical chart.  MCL 750.492a.  The Public Health Code proscribes the knowing reused of certain medical devices.   MCL 333.20153.  The Department of Attorney General has a special division dedicated to the investigation and prosecution of healthcare fraud in all of its forms.

Under federal law there are a myriad of offenses that cover conduct in the healthcare area.  The general healthcare fraud statute, 18 U.S.C. § 1347, prohibits schemes to defraud healthcare benefit programs, punishing such conduct with 10 years’ imprisonment.  It is also a crime to make a false statement in connection with a healthcare benefit program.  18 U.S.C. § 1035.  The improper use of medical devices can also give rise to criminal liability in different ways.  It can be considered adulteration under the Food, Drug & Cosmetic Act, 21 U.S.C. § 331, et seq., and if done with intent to defraud the penalty is three years’ imprisonment.  In fact, there is a strict liability version of the offense – requiring no criminal intent – that is punishable by a year’s imprisonment.  In some instances, such conduct can be considered tampering with consumer products giving rise to criminal liability with varying penalties.  18 U.S.C. § 1365(a).  Moreover, use of the proceeds of a fraud creates the potential of charges for money laundering.  18 U.S.C. § 1957.  The federal anti-kickback statute, 42 U.S.C. § 1320a-7b, makes it unlawful to exchange, or offer to exchange, anything of value in order to obtain a referral of business reimbursable under a federal healthcare benefit program.  The Stark Law, 42 U.S.C. § 1395nn, also applies to improper referrals and prohibits a broad range of financial relationships among physicians.  These offenses are typically investigated by the Federal Bureau of Investigation, the Department of Health & Human Services, the Food & Drug Administration, and other federal agencies.

Criminal investigations can begin in a number of ways – from patient complaints and payor review of claims history – and seeking representation from a health care fraud lawyer and white collar criminal defense lawyer as soon as possible is essential to protecting yourself against unfounded allegations.  The Grand Rapids lawyers at Willey & Chamberlain handle these types of cases regularly and are uniquely qualified to do so.  Call us for help: (616) 458-2212.