charges usually arise when a doctor or other healthcare provider defrauds a federal government healthcare program or insurer. Doctors, nurses, nurse practitioners, and physical therapists are the most common defendants in healthcare fraud cases. Many cases of healthcare fraud against medical doctors are prosecuted in . If you have been charged with healthcare fraud in Pennsylvania, hire a knowledgeable criminal defense lawyer to represent you throughout your case.
Attorney Brian J. Zeiger has the knowledge and experience to safeguard all of your legal rights while your criminal case is pending, and can help you formulate good legal defenses to your healthcare fraud charge.
Examples of Healthcare Fraud in Pennsylvania
Pennsylvania doctors may be charged with healthcare fraud in the following situations:
- When a doctor engages in the illegal practice of “upcoding” services, or billing for services that were costlier than what were actually provided to the patient
- When a doctor engages in the illegal practice of “upcoding” items, or billing for items that are costlier than what the patient actually received
- When a doctor bills for duplicate services, which includes billing Medicare twice for the same or similar services by slightly altering the bills and invoices
- When a doctor bills for unnecessary services, which usually involves filing Medicare claims for care that a patient did not actually require under the circumstances
Proving that a Doctor Committed Healthcare Fraud
To prove that a doctor committed healthcare fraud, a prosecutor must prove the following elements beyond a reasonable doubt—or beyond a doubt based upon ordinary reason and common sense:
- The defendant doctor knew the healthcare claim was false or fraudulent.
- The defendant doctor intended to defraud the medical insurance company or program or knowingly provided unnecessary services to the patient.
- Potential Defenses to a Healthcare Fraud Charge
- Pennsylvania doctors who have been charged with committing healthcare fraud may use the following defenses:
- Lack of knowledge or mistake of fact – in cases where a doctor is careless or makes a billing mistake.
- Lack of specific intent to defraud – in cases where a doctor does not intend to commit a crime or does not intend to defraud anyone.
Possible Penalties upon Conviction
Crimes involving healthcare fraud are serious and can result in severe criminal penalties, depending upon the amount of the claim involved. Such penalties can include the payment of large fines, the payment of restitution to the victims, and jail time.
Contact a Philadelphia, Pennsylvania, Healthcare Fraud Defense Attorney Today to Discuss Your Case
If you are a physician and have been charged with healthcare fraud, attorney Brain J. Zeiger can discuss the facts of your case, work to formulate potential legal defenses to your charge, and represent you in court if necessary.